Danebank

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

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.

Right Support:

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Where some restrictions had been put in place to manage risk, best interest decisions had not always been recorded and reviewed.

Significant repairs due to damage, and cleaning were required within a particular area of the service. The provider had not acted in a timely way to ensure the environment was currently clean and properly maintained. Systems in place to ensure the safety of the environment needed to be more robust. Whilst maintenance and various checks were carried out, there were some gaps and actions required. The manager agreed to address this straight away.

Systems to ensure staff had undertaken all relevant training and received an appraisal were not sufficiently robust. Staff received an induction and various other training was offered, as well as regular supervisions. However, some staff had not completed all the relevant training and annual appraisals had not been carried out.

Overall, people received their medicines safely. However, records relating to the use of “as required” medicines needed to be more specific. The provider had a policy for infection prevention and control. However, they had not ensured staff were fully following guidance in relation to the use of PPE.

There had been some staff changes but there was a consistent team of staff, who knew people well. Agency staff were used to fil any gaps and processes had changed to ensure these staff were as consistent as possible. Staff were recruited safely.

Right Care:

People appeared to be at ease and looked comfortable with the staff. Relatives told us their loved ones seemed safe and well cared for. The provider was working closely with other health and social care professionals, where there were concerns about the most appropriate care and support for a person.

Overall, people's needs and risks were assessed. Staff understood how best to support people. However, risk management information for one person needed to be more reflective of their current changing needs. Care records were in different formats for each person and were difficult to navigate. The new manager was in the process of reviewing these and implementing new care plans.

Right Culture

Overall, there was a positive culture and staff worked in a person-centred way. However, relatives felt they could be better involved in planning and reviewing their family member’s care. There were no restrictions on visiting. The provider had a positive behaviour support team to help support people and staff with their approach.

There were systems for oversight, but these were not always effective in ensuring all areas for improvement were identified and actioned in a timely way and accurate records were being kept.

Staff had undertaken training in safeguarding and understood their responsibility to safeguard people. However one incident had not been reported under local procedures as required. The provider had not ensured CQC were notified of certain events as legally required. There was a new manager at the service. Staff felt supported and able to raise any concerns. The management team were responsive to feedback and had started to take some action to make improvements.

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 5 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We have identified 4 breaches in relation to consent to care, the premises, systems to monitor and improve the quality and safety of the service and notifying CQC of certain events.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Danebank 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 home can accommodate up to four young adults with a learning disability. There were two people living at the home time of our inspection.

The home 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.'

The home has 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered provider had safe recruitment systems in place. All directly recruited and agency staff had completed an induction. All staff had undertaken mandatory training in accordance with best practice guidelines. Staff received on-going support through staff handovers and team meetings. Staff told us they felt well supported.

People had their needs assessed before they moved into the home and this information was used to create individual person centred care plans and risk assessments. These documents included clear guidance for staff to meet individual people’s needs. People’s needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment care planning process.

Staff had developed positive relationships with the people who lived at the home. We saw that people’s privacy was respected and their independence was promoted. We observed many positive interactions between staff and the people living at the home throughout our inspection.

The registered provider had safeguarding policies and procedures in place that staff were familiar with. All staff had received training and were able to describe what abuse may look like in the process they would follow to raise any concern.

Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. The registered provider had medicines policies and procedures in place that all staff were familiar with. Staff had all risk received training in medicines administration and had their competency regularly assessed.

People’s food and drink needs were met and clear guidance was in place for staff to follow to meet people’s specific dietary needs. People’s food likes and dislikes were clearly documented.

People living at the home engaged in activities of their choice both within the home environment and the community.

The registered provider had audit systems in place that were consistently completed. The audit system identified areas for development and improvement within the home.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we found. We saw that the registered provider had guidance available for staff in relation to the MCA. Staff had undertaken training and demonstrated a basic understanding of this. The registered provider had made appropriate applications for the Deprivation of Liberty Safeguards (DoLS). Care records reviewed included mental capacity assessments and best interest meetings.

There was a clear complaints policy and procedure in place that relatives knew how to access and they felt confident to raise any concerns they had. This document was available in an easy read and pictorial format.

Policies and procedures were available for staff to offer them guidance within their role and employment. These were regularly reviewed and updated by the registered provider.