This inspection was undertaken on 18 and 23 January 2019.

Dalvington/The Oaks 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. Dalvington/The Oaks accommodates 13 people in two adapted buildings and is designed to meet the needs of people with a learning disability. On the days of our inspection 13 people were living at the home.

The provider had adopted some of the principles and values that have been developed and designed to underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The aim is that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post who was present during our 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.

At the last inspection of the service on 30 January 2017 the service was rated as 'Good' overall. On this inspection we found the provider had not maintained their rating of 'Good' overall and we have changed the rating to 'Requires Improvement' overall.

Staff and the management team knew how to report allegations of abuse. However, we identified three potential safeguarding incidents which had not been reported to the local authority or the Care Quality Commission.

The provider’s and registered manager’s quality checking arrangements were not consistently robust and effective in ensuring there was an effective oversight of the home. The issues and risks to people’s safety and welfare we identified during our inspection had not always been effectively reduced by the management teams own checking procedures.

There were risks to unauthorised people having access to people’s personal information because this had not been stored securely. Some environmental risks required a more robust oversight to ensure people were not at risk from infections spreading and or of avoidable harm due to radiator tops being loose.

Staff had been provided the training relevant to the need of people they provided care to. The registered manager had a training planner and this showed staff training was being refreshed when required in line with the provider’s expectations.

Staff were knowledgeable about the support and equipment people required to reduce risks to their individual safety and welfare. Where people required wheelchairs or shoes adapted to meet their needs these were in place through consultation with healthcare professionals as required.

The registered manager kept staffing numbers under review and had increased these to meet people's needs. We have made a recommendation about staff deployment to ensure this is kept under review too so risks to people’s safety were reduced further.

People's individual needs and requirements were assessed prior to them moving into the home. People had support to eat and drink safely and comfortably, and contact had been made with various healthcare professionals where required to obtain advice about meeting people's nutritional needs. Staff supported people to maintain their health alongside relative's involvement.

People were supported to have maximum choice and control of their lives and staff always support them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff obtained people’s consent by using their preferred communication methods whilst supporting people’s care.

Staff supported people with kindness. People had support to express their views an

The inspection was unannounced and took place 30 January 2017.

Dalvington/The Oaks provides accommodation and personal care for a maximum of 15 people who have a learning disability, some of whom also have physical disabilities. The home consists of two separate bungalows, one called Dalvington with accommodation for seven people, and one called The Oaks with accommodation for six people. There were 13 people who lived at the home when we visited.

At the last inspection on 16 and 17 December 2014 the service was rated as good. Since the last inspection a new registered manager had been appointed. 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.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met. People were supported by staff to have their medicines when they needed them and staff recorded when they had received them. Staff had received medication training and there were arrangements in place for managing people’s medication safely.

Staff were available to meet people’s needs promptly and they demonstrated good knowledge about people living at the home. Staff we spoke with felt they had the right skills to support people living at the home and attended regular training to ensure they kept their knowledge updated.

The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). Staff sought the consent of people before providing care and people could choose the support they received.

People were involved in choosing their meals and staff were seen to assist people to eat and drink where needed. People were supported to access professional healthcare outside of the home, for example, they had regular visits with their GP. Where appointments were needed at hospital these were supported by staff and any changes to care needs recorded and implemented.

People were comfortable around staff providing care and relatives told us people had developed good relationships with staff. Staff showed us that they knew the interests, likes and dislikes of people and people were supported to enjoy various activities. We saw that staff ensured that they were respectful of people’s choices and decisions.

Relatives said communication was good and staff and the registered manager were available to them. They said staff listened to them and they felt confident they could raise any issues should the need arise.

People, relatives and staff were all complimentary about the service provided. The registered manager demonstrated clear leadership and staff were supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes. The management team ensured regular checks were completed to monitor the quality of the care that people received and action had been taken where areas were identified for improvement.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with a relative and a visitor, the registered manager and four carers. We also reviewed records relating to the management of the home which included four care plans, four daily care records, and three food record charts. We looked at the results of the latest satisfaction survey, health and safety and personal finance audits.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

Although there had been staffing vacancies in the past, new staff had been recruited and were in post or due to commence working within the month. Carers told us that they had sometimes been short of enough staff who knew people and a person had completed a survey and said, “any problems arise when staff who do not know the person are not available.” This showed us that there had been problems in the past but that the service had taken steps to address them. Daily staff numbers had varied according to the activities and needs of people using the service.

We saw that a comprehensive risk assessment had taken place before people had gone to live at the home. These were not all updated annually although they were audited by carers every three months. No action plan was in place if changes were needed. A person who had a percutaneous epigastric tube (PEG) did not have a care plan for the care and use of it. All of the people using the service had communication difficulties and all the care plans that we saw reflected this. However, we spoke with a carer in one house who told us that they had not read any care plans for people living there because they usually worked in the other house. They did not know the specific care or communication needs of the people living in the house.

A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

One relative that we spoke with by telephone told us that they visited at different times and were unannounced. They said the person using the service, “Is always smiling and is always clean and tidily dressed.” They thought that the carers were generally very good. Another frequent visitor said that the person using the service “loves it here” and “always looks well looked after.”

Most of the comments made in the annual satisfaction survey were positive. One person described the service as, “the perfect home for (the person).” Another said, “I can tell by regular visits that (the person using the service) is happy there and is well cared for.”

People were offered a variety of food, including fruit and vegetables. People who needed help to eat were assisted at mealtimes. We saw that food charts were kept for people who had assessed nutritional needs.

All staff had received the appropriate training to meet people’s needs, which included training about safeguarding people and healthy eating.

Is the service caring?

The service was caring. A relative that we spoke with told us, “I think staff are caring.” They said that carers always made them feel welcome to the house" and that it felt like a family home. A visitor said, “They are very caring, I can see that.” A person who completed the survey said, “Most of the staff are wonderful and caring.”

All but one of the carers that we spoke with knew people’s needs and we observed them interact with different people in ways that they could understand. A carer talked with us about a person. They told us what the person liked to do and what could make them anxious or upset in a way which showed us that they cared about them. They said, “my job is to help give people the best life I can.” Also, “I like seeing them smile.”

Is the service responsive?

People’s preferences, interests and aspirations had been recorded. All but one of the carers that we spoke with could tell us what these were for different people. We saw that a person wanted to go on holiday and this was being planned for. People took part in a wide range of activities that they enjoyed. A relative told us a person, “does lots of things (they) didn’t do at home. (They) would be bored at home now.”

We saw that when relatives could not visit people, the service arranged for carers to take people to their homes to visit. A person told us that they had made suggestions to improve the outdoor spaces so that more people could enjoy them. They said that plans had been made in response. We did not see evidence that there service had responded to the latest survey where only four people believed that there were agreed outcomes for the people using the service. Nine people had completed the survey. We did not see that any attempt had been made to engage people using the service in a survey, in a format they could understand.

Is the service well led?

The service had a recently registered manager. Not all of the carers that we spoke with knew that they were the permanent manager. There were also two deputy managers. Carers said that the managers were supportive and approachable and that they had regular supervision meetings. Appraisals had not all taken place in 2013 but were on course to be completed in 2014. The provider sent an annual satisfaction survey to monitor what relatives thought about the quality of the service, although we did not see an action plan based on the results, to make improvements. Two people who completed the survey said that the service was improving. This all showed us that the service was making improvements to the way it was led.

During the inspection we spoke with the relatives of five people who used the service, a visiting professional and five members of staff. We also spent some time in communal areas observing the interaction between staff and people who used the service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We used SOFI to observe how people were feeling and their engagement with staff. We found that overall people had positive experiences. People who used the service appeared calm and relaxed in the environment and responded positively to interactions with support workers.

The individual needs of people were assessed and supporting plans had been developed which were reviewed regularly. But we found that there were not always sufficient numbers of suitably skilled staff available to ensure people could pursue interests outside of the service.

There were appropriate arrangements for management and administration of people’s medication and people who visited the home told us that that they had no worries about the care of people who used the service. They said that they felt they were kept safe from the risk of harm.

We saw that there were arrangements for monitoring the quality of the service and people told us that they felt comfortable raising issues of concern with management if necessary.

We did this review because we had issues raised by a whistleblower who was concerned about events in Dalvington (but not The Oaks) which they had reported to the manager. These incidents involved inappropriate verbal remarks about bodily functions and sexual innuendo made by some staff to and about people who live in the home. The concerns also included lack of attention to some people’s care and staff going off duty and leaving the home short staffed for periods of time. The nature of these concerns mean that some people living in Dalvington had potentially unpleasant experiences or were deprived of the time and attention they had a right to expect. It may have been that they would not have understood that this was the case but this is irrelevant and reflects poorly on the attitudes of staff to the people whose home Dalvington is.

From conversations with people who work at the home we learned that many of them have worked at the service for many years, some up to 12 or 15 years. People who live there have also been there a long time. Because of this some support staff know people well and understand their needs and their methods of communication. During our visits we saw that people living at the service appeared to be at ease with the people supporting them and there was a relaxed atmosphere.

We spoke with five health and social care professionals who have had dealings with the service. They gave us a positive picture of good communication and a helpful staff team. They told us that people live varied lives and are supported well by staff.

One health professional told us the service liaises well when people need to use NHS services and confirmed that when a person was in hospital recently there was a member of staff from the home at the hospital with the person at least three times a day.

We found that the records about people’s care needs, including their medicines did not provide clear and up to date information about how staff working at the home should support them. Some information was dated several years earlier and we saw some records which contradicted other information we had read. We were not confident that the records we saw would provide staff with reliable information to help them support people safely.

Staff told us that people were not always able to do planned activities because of staffing shortages and as an example we saw in a persons’ records that one of their weekly activities had sometimes been cancelled because of this.

We observed that there was a tendency for people to go to bed early. Staff told us that this was what people needed and wanted. We saw an entry in one person’s records which suggested they had gone to bed earlier than they wanted on a recent evening to because they had kept getting back up. Staff had written that the person had “finally settled at about 8ish”. We also saw evidence of a care record being written in advance on the evening of our visit, about a person going to bed at 8:45pm when we saw them still up and about at 9:00pm. This gave us cause to question the reliability of the records we saw at the home.

People living at Dalvington/The Oaks have communication needs which mean that it may not always be possible for them to make their views known. This means that other ways to check that people are having their needs met are very important. During our two visits to the service we identified areas of concern which we would have expected the organisation’s own quality monitoring arrangements to pick up and deal with. We identified a number of areas where this had not happened.

Dalvington/The Oaks provides accommodation and personal care for a maximum of 15 people who have a learning disability, some of whom also have physical disabilities. The home consists of two separate bungalows, one called Dalvington with accommodation for seven people, and the other called The Oaks with accommodation for six people. There were 13 people who lived at the home when we visited.

This was an unannounced inspection, which took place on the 16 and 17 December 2014.

At our last inspection in May 2014 the provider was not meeting the essential standards of care and welfare. This was because the provider had not taken the proper steps to ensure people were protected against receiving inappropriate or unsafe care. At this inspection we found that improvements to keep people safe had been made.

There was a registered manager in post at the time of our 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.

People and their relatives said they felt safe and staff treated them well. Relatives told us that staff were kind and caring and thoughtful towards people. We saw that staff treated people with dignity and respect whilst supporting their needs. Peoples preferred method of communication was taken into account and respected.

Staff we spoke with understood that they had responsibility to take action to protect people from harm. They demonstrated awareness and recognition of abuse and systems were in place to guide them in reporting these.

Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs in a timely way. People were supported by staff with up to date knowledge about providing effective care.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and The Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager understood her role and responsibilities.

People were appropriately supported and had sufficient food and drink to maintain a healthy diet.

Risks to people’s health and wellbeing were well managed. People were supported to eat and drink well and had access to health professionals in a timely manner.

Relatives knew how to raise complaints and the provider had arrangements in place so that people were listened to and action could be taken to make any necessary improvements.

There were systems in place to monitor and improve the quality of the service provided. Where improvements had been identified the registered manager had responded and there were plans in place for further improvements.

The registered manager promoted a positive culture that was inclusive. People and staff were involved in regular house meetings to share their thoughts and concerns through an open communication system.