We carried out a comprehensive inspection of Daneswood Care Home on 14 January 2017. This was an announced inspection. We told the provider four days before our inspection visit that we would be coming. This was because we wanted to make sure people would be at the service to speak with us. The service was last inspected in July 2014. The service was meeting regulations at that time.

Daneswood Care Home provides care and accommodation for up to twenty people with complex needs who have a range of learning disabilities and include autism. At the time of the inspection 15 people were living at the service.

There was a registered manager in post. 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 consistently told us that they thought the service provided an excellent standard of care and support to their relative living at Daneswood care home. They told us, “Very caring. Couldn’t ask for more. It gives us peace of mind,” “A gem of a service. Staff are so supportive,” “Excellent. The communication is very good” and “If there are any changes at all they (manager) lets us know."

The service had received numerous compliments and positive comments. These included, “Extremely competent,” “They are very good at listening and acting on advice,” “Daneswood had a gentle, caring and encouraging ethos in which people flourish” and “With great confidence we can say that placing (person’s name) at Daneswood was the best decision we ever made.”

Family members told us they believed their; relatives had a lot of opportunities to lead a good quality of life within the boundaries caused by their disability. They told us they felt their relative was supported safely and with respect. Comments included, “It’s been a great move for (person’s name). They are so happy at Daneswood it’s an excellent place for people to live if they need the level of support (person’s name) needs” and “The staff are wonderful. It’s really important (person’s name) had the same staff team and on the whole this happens. It gives us total peace of mind.”

People living at Daneswood Care Home were supported to lead fulfilled lives which reflected their individual preferences and interests. Each person was supported by a member of staff called a key worker. A keyworker in the care sector is a member of staff assigned to support a specific person. In some instances people were supported by two keyworkers. There were enough staff available to make sure everyone was supported according to their own needs. Staff told us they loved their jobs and felt they had all the support they needed to carry out their role. They told us, “Could not imagine working anywhere else” and “I wish I had come into this work a long time ago. It’s the most satisfying job I’ve ever had.”

Staff were observed to be very attentive and available to people. They did not restrain people or prevent them from going where they wished. We observed staff encouraged people to engage in meaningful activities and spoke with them in a friendly and respectful manner. Where a person was upset the staff member was able to engage with them and focus on another activity, which calmed the person quickly. It demonstrated staff knew the person well and how to manage an event in a calm and controlled way.

People were fully supported to follow their interests and take part in social activities. The home had a wide range of meaningful activities suited to people’s individual needs and which brought positive outcomes and enhanced their quality of life. Staff members were available to support peoples’ needs and engage in a range of activities. For example people were engaged in crafts and artwork. Others chose to walk around areas of

The inspection was carried out by one inspector, who answered the five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. The provider responded appropriately to an allegation of abuse.

When people were at risk, staff followed effective risk management policies and procedures to protect them.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Relevant staff had been trained to understand when a DoLS application should be made, and in how to submit one. This meant that people were protected from discrimination and their human rights were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

Care plans reflected people’s current individual needs, choices and preferences. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People’s health was regularly monitored to identify any changes that may require additional support or intervention.

Staff supported people to take informed risks with minimal necessary restrictions.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people’s needs when they needed it.

Parents and staff completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Appropriate professionals were involved in planning, management and decision making.

Is the service responsive?

Where appropriate, a person’s capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People had their individual needs regularly assessed and met.

People completed a range of activities in and outside the service regularly. People had access to activities that were important and relevant to them and were protected from social isolation.

Is the service well-led?

There was a registered manager in post and all other conditions of registration were met.

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Robust quality assurance and governance systems were in place and used to drive continuous improvement.

Concerns and complaints were used as an opportunity for learning or improvement.

There were 17 young people living at the home on the day of our inspection. Due to the complex needs of the people we were unable to talk to them in detail about their experience of living at Daneswood. However, we observed their behaviour and interacted with many of the people living at the home. People seemed settled and comfortable in their environment and interactions with the staff working at the home.

We saw that staff communicated well with people and encouraged them to be independent and make choices about their every day life.

People’s needs were assessed and where needs were identified care plans were developed to ensure these identified needs were met.

People were supported to access GP’s, dentist, optician’s and other health professionals when appropriate. We saw that care plans were in place for specific health conditions such as epilepsy which were reviewed regularly by the staff with input from health professionals.

The home provides people with a balanced diet of organic, locally produced, home cooked food. We observed that people were supported to eat and drink by staff as described in their care plans.

We found the home had effective procedures in place to manage medication safely.

We examined the home’s recruitment procedures and found that these were robust and ensured that suitable qualified and experienced staff were recruited to work at the home.

Appropriate arrangements were in place in relation to the recording of medicine.

We undertook an inspection on the 11 and 12 October 2012 where we found the provider was not meeting one of the ‘Essential Standards of Quality and Safety’. Following which we served a warning notice to the provider on outcome 16, ‘assessing and monitoring the quality of service provision’. We informed the provider they were to be compliant by 8 December 2012.

The provider sent us a copy of their action plan in November 2012, and kept us informed of their ongoing progress in respect of meeting the action plan. This included sending us supporting documents to demonstrate compliance. The purpose of this inspection was to review the warning notice, to check that the necessary improvements had been made.

Since our last visit a new permanent manager had been appointed and was in the process of receiving a handover from the interim manager. Staff we spoke with were very complimentary about the new manager and said that they were very approachable.

During our visit we found that systems had been put in place to ensure that the service provided, was regularly assessed and monitored in relation to the quality of service that people received. The provider was now meeting this essential standard.

Most of the people who lived in the home were unable to communicate verbally with us. We spoke with one person who had a certain level of communication who was able to tell us that they thought the home was “good”. Therefore 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 were unable to talk with us.

We observed five people with their care staff sitting in the lounge area and saw good interactions between the staff and the people they supported. People looked well cared for and the majority of people were engaged with the staff or with an activity or task. People appeared to be at ease and happy in the presence of the care staff and other people who lived in the home. We observed that staff appeared confident and competent when supporting people with their care needs. Also in our conversations with staff they were knowledgeable about people’s needs and personal preferences.

Evidence from the home’s satisfaction questionnaires and our own observations of the care provided by the staff demonstrated that the outcomes for people who lived in the home were generally good. Nevertheless we had a number of concerns because other evidence from our inspection identified some potential risks to people’s health and welfare although we judged these had a minor impact on people who lived in the home. We were concerned about the possibility of interactions between complimentary and traditional medication. The provider’s quality monitoring and incident reporting systems were not always effective in identifying important issues. Staff were unsure about the processes they needed to follow to ensure that decisions about people’s care were always made in the person’s best interests.

The provider asked representatives of people who lived in the home for their views about people’s care and treatment. We looked at the summarised outcomes from the home’s 2011 annual quality assurance questionnaire. This was sent out in July 2011 to people’s families and to other interested parties such as commissioners, social workers and health professionals. Overall the results showed a high level of satisfaction with the service provided. The average response from families gave a 90% satisfaction rating and from other parties 88% satisfaction. The main area where people expressed dissatisfaction related to communications. This included delays in returning relatives phone calls and messages.

People living at Daneswood have limited communication abilities, but we found they are kept at the centre of plans about the way the service is delivered. Staff working at the home are skilled at understanding their needs through non verbal communication signals. The support staff are carefully selected to work with individuals and have the necessary skills and qualities to provide people with the care and support that they need. Individual care and support needs are met because care planning is well organised. Each person is looked after by a dedicated team of support workers led by a senior member of staff.

People are provided with the opportunity to participate in a wide range of community activities, including college and social functions. In-house activities are arranged and each person has a meaningful activity plan each day and week.

The home is comfortable, well equipped and clean, tidy and fresh smelling.

We saw that people who lived in the home were each supported by a small team of staff who only worked with that person. People were supported consistently by staff to work towards their own goals. The interactions we observed between staff and people living in the home were appropriate and caring.

We spoke with two relatives who were both happy with the service their relative received.

We were told by staff how people made choices, how they communicated that they were in pain and whether they were happy or sad. Staff had received training in the Mental Capacity Act 2005. People who did not have capacity to make decisions had decisions made for them in their best interest.

We saw that people who used the service were protected against the risk of unlawful or excessive control or restraint. This was because the provider had made suitable arrangements to ensure that it was only used safely and when necessary for the safety of the individual or others.

Appropriate arrangements were not in place in relation to the recording of medicine. At the time of the visit staff did not have access to a clear up to date medicine policy describing how they were expected to handle medicines.

Although the home had a quality monitoring system in place, this was not working effectively to identify and minimise risks and improve the quality of the service. There was no overall analysis of incidents that took place which looked at frequency, trends and potential learning.