Archived: Dinorwic Road

Dinorwic Road provides specialist care for people with learning disabilities and/or autism. The home is registered to provide care for three people. At the time of our inspection there were two people living at the home. Dinorwic Road is a large domestic property in a residential area of Southport close to local amenities.

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 Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

People’s experience of using this service

People’s individual needs and preferences were consistently considered as part of the care planning process. Their needs and preferences were reflected in the way care was provided. Care and communication methods were sensitively adapted to promote people’s independence and choice. People were encouraged and supported to take the lead in assessment and care planning processes with the support of staff. People and their relatives were actively involved in setting and reviewing short and long-term goals. There was clear evidence this approach had improved people’s skills and independence and reduced anxiety.

Staff understood the need for effective communication and exceeded the requirements of the Accessible Information Standard. Important information was also made available in a range of accessible formats to help people understand and to promote their involvement in decision-making. Staff’s creative and flexible approach to communication meant people could always express themselves. There was evidence in care records this had resulted in lower levels of high-risk behaviours and improvements in people’s health and wellbeing. People were supported to enjoy a range of personalised activities in their own home and the wider community. Activities reflected people’s needs and preferences and were also beneficial in developing their independence.

Systems and processes for keeping people safe were highly developed and effective. Risk was assessed in good detail and supported by appropriate care plans. There was clear evidence of the service learning from incidents and feedback. Staff were deployed safely in accordance with people’s needs. Medicines were managed safely in accordance with best-practice guidance.

Staff were given a thorough induction and supported with regular additional training and supervision. People were supported to exercise choice and were involved in shopping for ingredients for their meals. The building had been decorated in a way which reflected the preferences of the people living there and was noticeably homely. There was evidence of regular contact with community health services and referrals were made in a timely manner. The service was working in accordance with the principles of the Mental Capacity Act 2005 (MCA). People were asked for consent and given choices in relation to their care and other important decisions.

People living at the home were treated with kindness and respect. There was a strong, natural person-centred culture which was evident in our observations and the actions and comments of all staff. People were encouraged to comment on the provision of care and were actively involved in the decision-making process through discussions with staff and regular reviews. People’s rights to privacy and dignity were maintained at all times.

The managers and the staff we spoke with demonstrated their commitment to providing high-quality, person-centred care. Staff understood their roles and responsibilities within the service. Safety and quality were effectively managed through the application of robust systems. The provider placed continuous learning and improvement at the heart of their practice. Lessons learnt from incidents and accidents were shared with staff to improve practice.

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.

Rating at last inspection and update

The last rating for this service was Good (published 28 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dinorwic Road on our website at www.cqc.org.uk.

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.

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

Dinorwic Road is a care home for up to three vulnerable adults who require residential support. The home is situated in a residential area of Southport, close to local amenities. The home has three separate bedrooms, two bathrooms, living area, dining area, kitchen area and communal grounds.

At the last inspection, in January 2015 the service was rated Good.

At this inspection we found the service remained Good.

The was no registered manager in post at the time of the inspection however an application had been submitted by the interim manager who was awaiting approval from the Care Quality Commission.

The interim manager had processes in place to ensure the safety and well-being of those living at the home was paramount. Our observations and discussions with staff and relatives confirmed that the staffing levels were sufficient for the support which needed to be provided.

The home operated within the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). We were provided with information in relation to capacity assessments and processes which needed to be in place to make decisions in a person’s best interest.

Medication was administered safely by staff who had been appropriately trained. We were provided with evidence of competency assessments which had been carried out on staff. Medication records were accurate and systems were in place to order repeat medication, dispose of medication and record any medication discrepancies. An audit of the administration of medicines was completed each month.

All care files contained individual care plans and risk assessments which were regularly reviewed and updated in order to minimise risk. Care plans were person centred and contained relevant information in relation to a person’s wishes, choices and preferences.

Risk assessments and behavioural management plans were in place for people who presented with complex behaviours. The assessments offered key information to staff about how to manage any challenging situations for the safety of everyone who lived in the home.

Staff told us they felt supported in their roles. Staff had completed the necessary training to help them fulfil their roles and expressed how the home was safe and caring.

We observed staff supporting people with the preparation of food as well being responsive to specific activity requests for people living at the service. One staff member said, “It's all about choice, there is lots of choice, if they wish to go out, we take them out.”

A complaints process was available at the home but we were informed by relatives that any complaints or concerns could be discussed openly with the staff and managers. Relatives told us their loved ones were living in a safe and caring environment.

The service regularly held ‘Your Voice’ meetings with the people living at the home. This meant that the people’s ideas, suggestions and choices were being listened and responded to.

There was a variety of different audit tools and methods used to monitor and assess the quality of the home. These included internal and external audits as well as staff meetings, ‘Your Voice’ meetings and regulatory compliance checks.

Further information is in the detailed findings below.

Positive communication was evident between the staff and the people they supported. There was plenty going on during the day and people appeared comfortable and relaxed with the staff. There was plenty of laughter and chatter. Staff demonstrated a good understanding of people's individual needs and how they wish to be treated and supported. We saw this when the staff assisted people with personal care and daily life skills and tasks.

At the time of our inspection we found the home to be clean. Systems were in place to monitor infection control and staff had access to protective equipment, such as gloves and aprons to ensure good standards of hygiene.

The home was subject to an on-going programme of decoration and maintenance to enable people to live in safe pleasant accommodation.

Sufficient numbers of skilled and experienced staff were available to provide support to people in accordance with their individual need.

Systems were in place to ensure the home was managed effectively and safely. People who lived at the home were involved in how it operated.

During our visit we spoke with the new manager, the operations manager and three members of staff. We also received comments from other agencies such as, the local contracts team who work along side social services to enable us to get an overview of the service provision. No concerning information was brought to our attention at the time of our visit.

Staff interviewed were knowledgeable regarding the care and support people at the home needed and they described their individual routines and how they respected these to promote people's independence. A staff member said, "This is their home and we need to make sure things are right."