Dunelm

Dunelm is a residential care home providing care and support to people with a learning disability, autism, or both. At the time of the inspection 3 people were receiving care and support. The service can support up to 4 people.

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last inspection we rated this key question good. At this inspection, the rating remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Managers and staff being clear about their roles, and understanding quality performance, risks, and regulatory requirements.

¿ People’s support plans and relevant documentation included risk assessments that highlighted where risks needed to be mitigated. These were reviewed by the manager.

¿ Audits were carried out regularly by the manager, who was able to identify and address issues effectively.

¿The provider invested in staff by providing them with quality training to meet the needs of all individuals using the service.

Promoting a positive culture that is person-centred, open, inclusive, and empowering, which achieves good outcomes for people

¿ The manager encouraged people and staff to be open with each other. Staff felt supported by their colleagues and the manager.

¿ The manager promoted equality and diversity in all aspects of the running of the service.

¿ Staff felt able to raise concerns with the management.

¿ People’s relatives shared their feedback with us on the positive culture of the service.

How the provider understands and acts on the duty of candour, which is their legal responsibility to be open and honest with people when something goes wrong

¿The manager was aware of their responsibility under the duty of candour regulations.

¿There had been no recent incidents that required a response under the duty of candour.

Engaging and involving people using the service, the public and staff, fully considering their equality characteristics

¿ Regular staff and resident meetings were held which gave the opportunity for people to raise any concerns and for the management team to inform people of any changes within the service.

¿ People, and those important to them, worked with managers and staff to develop and improve the service.

Continuous learning and improving care and working in partnership with others.

¿ The manager and staff team worked in partnership with advocacy organisations, social workers and other health and social care organisations to develop their service to meet people’s needs.

¿ The provider had an action plan for the service that was regularly updated and highlighted areas for improvement. One relative told us. “I can’t suggest anything to change. They provide a very safe and happy environment. The continuity of the staff helps. There have always been the three residents. They don’t take in more like so many other homes, putting money before the residents. I am very comfortable with everything about the home.”

¿ The provider ensured people and their families were involved in improving the service. One relative told us, “We had a family Zoom meeting recently about the new way of assessment. It was all explained on the Zoom meeting and then they sent all the paperwork out to read too. It was all very interesting and informative. Everything has been relayed back to let us know that staff are being trained now from senior management down. They said they would keep us informed and I am sure they will.”

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last inspection we rated this key question good. At this inspection, the rating remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Managers and staff being clear about their roles, and understanding quality performance, risks, and regulatory requirements.

¿ People’s support plans and relevant documentation included risk assessments that highlighted where risks needed to be mitigated. These were reviewed by the manager.

¿ Audits were carried out regularly by the manager, who was able to identify and address issues effectively.

¿The provider invested in staff by providing them with quality training to meet the needs of all individuals using the service.

Promoting a positive culture that is person-centred, open, inclusive, and empowering, which achieves good outcomes for people

¿ The manager encouraged people and staff to be open with each other. Staff felt supported by their colleagues and the manager.

¿ The manager promoted equality and diversity in all aspects of the running of the service.

¿ Staff felt able to raise concerns with the management.

¿ People’s relatives shared their feedback with us on the positive culture of the service.

How the provider understands and acts on the duty of candour, which is their legal responsibility to be open and honest with people when something goes wrong

¿The manager was aware of their responsibility under the duty of candour regulations.

¿There had been no recent incidents that required a response under the duty of candour.

Engaging and involving people using the service, the public and staff, fully considering their equality characteristics

¿ Regular staff and resident meetings were held which gave the opportunity for people to raise any concerns and for the management team to inform people of any changes within the service.

¿ People, and those important to them, worked with managers and staff to develop and improve the service.

Continuous learning and improving care and working in partnership with others.

¿ The manager and staff team worked in partnership with advocacy organisations, social workers and other health and social care organisations to develop their service to meet people’s needs.

¿ The provider had an action plan for the service that was regularly updated and highlighted areas for improvement. One relative told us. “I can’t suggest anything to change. They provide a very safe and happy environment. The continuity of the staff helps. There have always been the three residents. They don’t take in more like so many other homes, putting money before the residents. I am very comfortable with everything about the home.”

¿ The provider ensured people and their families were involved in improving the service. One relative told us, “We had a family Zoom meeting recently about the new way of assessment. It was all explained on the Zoom meeting and then they sent all the paperwork out to read too. It was all very interesting and informative. Everything has been relayed back to let us know that staff are being trained now from senior management down. They said they would keep us informed and I am sure they will.”

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

People were supported by staff to pursue their interests. People took part in activities at home and within their local area. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcomes.

The service made reasonable adjustments for people so they could be involved in how they received their support. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

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.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so.

Right Culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People’s care, treatment and support plans had clear guidance on what people’s goals and aspirations were. The service enabled people and those important to them to work with staff to develop the service. We received positive feedback from people’s family members about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection and update

The last rating for the service was good (5 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and due to the length of time since the previous inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for

Dunelm on our website at www.cqc.org.uk

Follow up

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

Dunelm 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.

Dunelm accommodates up to four people in one adapted building. 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. On the day of our inspection there were three people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

We last inspected the service in December 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff.

There were sufficient numbers of staff on duty to keep people safe and support them in the local community. Staff were suitably trained and received regular supervisions and appraisals.

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 were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

Family members were complimentary about the standard of care at Dunelm. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were set targets, which were goals for them to work towards in areas such as improving independence and their quality of life.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had a complaints procedure in place. There had not been any complaints made however people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

Dunelm provides care for up to four people with a learning disability or autism spectrum disorder. At the time of our inspection three people were living at the home.

The home had 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.

Family members told us they were happy with their relative’s care. One family member said, “Excellent care. They are amazing.” Another family member commented, “Okay really, they care. They take care of [my relative] well.” Kind and considerate staff treated people with dignity and respect. One family member commented, “[My relative] has his dignity.” Staff supported people to develop daily living skills and promote their independence as much as possible.

Family members felt their relatives were safe living at Dunelm. One family member said, “[My relative] is very safe where he is. I would be the first to shout. I wouldn’t wish [my relative] to be anywhere else.”

Staff had a good understanding of safeguarding and whistleblowing, including how to report concerns. All staff had completed safeguarding adults training. One staff member said, “We are here to look after the service users. If I didn’t raise concerns I wouldn’t be doing my job.” Staff told us concerns would be taken seriously and investigated.

People received their medicines safely and on time from trained and competent staff. Medicines administration records (MARs) were accurate and regular checks were carried out to help ensure medicines were managed appropriately.

Potential risks had been identified and assessments were in place to guide staff about how to keep the person safe. For example, when people accessed the local community.

There were enough appropriately recruited staff to meet people’s needs and keep them safe. Staff told us staffing levels were under review due to a change in people’s needs within the service. One staff member said, “[Staffing levels were] fine as far as I am concerned. We have enough staff.” There were on-call arrangements in place should staff require assistance overnight.

A range of health and safety checks were carried out, such as checks of fire safety, firefighting equipment and emergency lighting. People had up to date personal emergency evacuation plans (PEEPs) to guide staff on how to keep people safe in an emergency. The registered provider had a business continuity plan to deal with emergency situations. Incidents were logged and a record of action taken to prevent the situation from happening again.

People were cared for by a skilled and well-supported staff team. One staff member told us, “I always feel I can go and talk to someone.” One staff member said, “All my training is up to date.” Records confirmed all training was up to date at the time of our inspection. Staff members told us they were able to discuss anything they wanted with their line manager.

The registered provider followed the requirements of the Mental Capacity Act 2005 (MCA). Deprivation of Liberty Safeguards (DoLS) had been authorised for all three people using the service following a MCA assessment and best interest decision.

Staff had a good understanding of people’s communication needs. They described how they supported people with making day to day decisions about their care. Staff adapted their communication style to meet the needs of individual people.

Staff had the skills to support people when they displayed behaviours that challenged. Staff used diversion, distraction and one to one counselling to support people at these times. Physical restraint was very rarely used within the service. One staff member said, “I have never used physical restraint.”

People had access to the healthcare they needed. One family member said, “They are good at watching [my relative’s] weight and exercise. They are very health conscious with [my relative].”

Staff had access to detailed information about each person’s needs, including a life history. People had their needs assessed when they accessed the service. Detailed and personalised support plans had been developed for each person. Family members said they were involved in this process. One family member said, “We are very much involved in what is happening.”

People were involved in a range of activities to keep them occupied and engaged. One family member said, “As far as I am concerned they give [my relative] a life.” Another family member said, “They take [my relative] out.” Activities included attending local football matches, bowling, going to the pub, walking and completing puzzles.

People were provided with information about how to complain in a format appropriate to their needs. One family member said, “I am not scared to say if I don’t like things.” They went on to say, “I have no complaints. I couldn’t fault them in any respect.”

Family members were consulted about their relative’s care and support. Feedback from recent consultation had been positive.

Family members and staff told us the registered manager and other staff were approachable. One family member told us staff at the service “are accessible.” One staff member commented, “Very approachable. If they are not on shift I can contact by email.” Staff told us the home had a positive atmosphere. One staff member said, “It is a really good house, we all get on well.”

There were opportunities for staff to give their views about people’s care, through regular team meetings. Meetings were used as a way of raising staff awareness of important information, such as changes to procedures.

The registered provider carried out regular quality assurance to check people received good quality care. Quality audits had been successful in identifying areas for improvement and ensuring the required changes had been made. Family members had given positive feedback about their relative’s care and support.

The registered provider aimed to continually look for ways to improve and develop its services. Annual self-assessments were carried out to help the registered provider continually improve its services. The registered provider had future development plans with timescales for completion identified.

We spoke to two members of staff who spoke positively and without prompt regarding local management, training and working conditions.

We reviewed the comments and complaints file kept in the office. There had been no formal complaints since any of the people who lived there had joined the home.