The Dunes

Updated 2 October 2019

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

The inspection was carried out by one inspector.

Service and service type

The Dunes is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 did not have a manager registered with the CQC. A registered manager and a provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection the manager had been in post for two weeks and had started the application process to register with us.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the manager would be in the office to support the inspection.

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. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service and two relatives about their experience of the care provided. We spoke with five members of staff including the manager, quality improvement lead, senior support worker and support workers. We also spoke with two regular agency workers.

We walked around the building and observed care practice and interactions between support staff, management and people.

We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, an internal development plan and governance meeting minutes. We spoke with one relative and one healthcare professional who visits the service.

Updated 2 October 2019

About the service

The Dunes is a residential care home providing accommodation and personal care for up to four people with learning disabilities. The service is a single-floor bungalow with a large rear garden. There were three people living at the home at the time of the inspection.

Services for people with learning disabilities and or autism are supported

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.

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.

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 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 and what we found

Staff knew what signs and symptoms could indicate people are experiencing abuse or harm. Staff felt confident management would listen and act if they raised concerns. There were enough staff to keep people safe and meet people’s individual needs. Staff had a good understanding of people’s individual risks and how to minimise them without being unduly restrictive. There were robust processes in place to ensure the safe recruitment of staff.

People were supported by staff who had received the necessary training and ongoing support to help them meet their diverse needs with confidence. Staff competency was monitored on an ongoing basis through observation, regular supervision and appraisals.

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 consistently 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.

Staff understood the principles of the Mental Capacity Act 2005 (MCA 2005) and how it applied to the people there. This provided protection for people who do not have capacity to make decisions for themselves.

Staff interacted with people in a consistently kind and caring way. There was a relaxed and friendly atmosphere at the home. People were given time to interact at their pace using their preferred means of communication. Staff responded to people with patience and understanding. People’s right to privacy and dignity was respected at all times.

People’s support needs, abilities and desired outcomes were identified, assessed and monitored in personalised care plans. People were encouraged and supported to maintain relationships with relatives and friends and socialise in their local community. Staff demonstrated a good understanding of the people living there and created opportunities for maximising their independence and life skills.

People’s care needs were monitored and regularly reviewed. The provider had established good relationships with health and social care professionals and relatives who were consulted and involved. Relatives felt listened to and involved in their family member’s lives.

People’s desire to socialise and participate in meaningful activity was met through a varied range of activities tailored to their tastes and abilities. This enabled them to lead full and active lives. The support people received recognised their needs as individuals and as part of a small community of people living in the same home.

Staff felt motivated and supported by their colleagues and the management; telling us the staff team were “like a family.” The manager had the skills, knowledge and passion to manage the service and work with staff and the provider to identify where it could be improved. People, relatives and staff were frequently consulted with their feedback used to influence what happened at the home.

A range of audits and checks helped ensure service quality was maintained and areas for improvement identified. Learning was shared with staff and used to develop the service.

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 10 March 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.