About the service:

Dorset Learning Disability Service – 11 Friars Close provides accommodation and care for up to four people with a learning disability. At the time of inspection there were four people living in the home.

People’s experience of using this service:

People did not always have their rights protected under the Mental Capacity Act 2005 (MCA). MCA assessments had been carried out but did not assess people’s capacity to make individual decisions. We spoke with the registered manager and they told us they were aware of this and had planned to complete the assessments. The registered manager sent us evidence that the correct assessments had been carried out following the inspection.

Staff and relatives told us people were safe and happy living at the home. The staff demonstrated a good understanding of how to meet people’s individual needs. People’s outcomes were known, and staff worked with people to help achieve these. People were supported and encouraged to maintain their independence and live their lives as fully as possible.

People were supported to maintain contact with those important to them including friends, family and other people living at the home. Staff understood the importance of these contacts for people’s health and well-being. Staff and people were observed enjoying warm and mutually beneficial interactions. Staff knew people well and what made them individuals.

The management of the home were respected by people, relatives and staff. Staff had a good understanding of their roles and responsibilities and were supported to reflect on their practice and pursue learning opportunities. The staff team got on well together demonstrating team work and flexibility.

Quality and safety checks were completed which helped ensure people were safe and protected from harm. This meant the home could continually improve. Audits identified areas for improvement and this learning was shared with staff.

The service met the values that underpin the 'Registering the Right Support' and other best practice guidance such as 'Building the Right Support'. These values include choice, promotion of independence and inclusion. Also, how people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service met the characteristics of good in all areas; more information is in the full report

Rating at last inspection:

This service was last inspected in December 2016 and was rated as good.

Why we inspected:

This inspection was scheduled based on previous rating.

Follow up:

We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The inspection took place on 8 November 2016 and was unannounced. The inspection was carried out by a single inspector.

The service is registered to provide personal care with accommodation for up to 4 adults with learning disabilities, autism and physical needs. The service has 4 bedrooms. The home had an open plan kitchen and dining area that people are free to use at any time. Two bedrooms had en suites and there was a shared bathroom. There was a staff sleep in room/office and kitchen. The dining area overlooks a patio area which leads into a level access patio and garden. There was a separate medicines room and laundry area.

The service had a registered manager in place. 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.

Staff were able to tell us different forms of abuse for example, financial, physical and neglect. They were able to tell us how they would recognise if people were subject to these forms of abuse and how they would raise their concerns with the manager. Staff were also aware of external agencies they could contact. Staff told us that they had received safeguarding training. We looked at the training records which confirmed this.

People who used the service had a Personal Emergency Evacuation Plan in place which were up to date and reviewed annually. These plans detailed how people should be supported in the event of a fire during the day and at night. There was also a Service Emergency Plan in place which detailed peoples profiles and emergency contact numbers. The plan covered emergency situations for example missing persons, failure of electric, water or gas leaks.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with on-going care needs.

Staff and relatives told us there were generally enough staff. We reviewed the last four weeks of rota and saw that it reflected the staffing numbers given by the registered manager. Recruitment was carried out safely. There was a system which included evaluation through interviews and references from previous employment. This included checks from the Disclosure and Barring service (DBS).

Medicines were managed, stored and administered safely. Medication was only administered by trained staff that had been signed off as competent.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training which was more specific to their roles for example autism awareness and epilepsy. A staff member told us, “We receive regular training; I recently did first aid which was good”.

People lacked mental capacity to make complex decisions about their health and care needs. Staff were aware of the principles linked to the mental capacity act and capacity assessments were completed and best interest decisions recorded appropriately.

People had a Deprivation of Liberty Safeguards (DOLs) application completed and sent to the local authority. Two peoples had been returned and were authorised. One person had just been assessed by their local authority and the other was still in the application process.

Staff were polite and treated people in a dignified manner throughout the inspection. If people required support with personal care they were discretely supported back to their room or to the toilet and doors were closed behind them.

People who use the service had complex health needs and used non-verbal methods of communication. For example body language, facial expression, gestures and visual prompts. There was guidance in place for staff to understand and communicate with people.

Staff told us that people would find it difficult to raise concerns and/or

People who lived in the home had been assessed as not having capacity to make some choices and decisions which affected their lives.

We found systems and safeguards to ensure people experience appropriate care and support and to protect their human rights were not in place.

We found people were unable to tell us what they thought about the care and support they received.

We found that people were unable tell us if they were comfortable and looked after well. We spoke with the registered manager and care staff who told us that staff provided the care and support they needed.

We observed that people’s privacy, dignity and independence were respected.

We observed that people were treated with respect and kindness when interacting with staff.

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found staff had completed safeguarding training and demonstrated skills and knowledge in this area. The home had an up to date safeguarding adults policy and processes that were accessible to staff.

Staff told us they felt supported and well trained for the job. We saw that they received training, supervision and peer support and annual appraisals.

We found the manager did not have systems in place to assess and monitor the quality of services.

The service supported four people with learning disabilities to live as independently as possible. The people were unable to tell us their views due to limited verbal capacity. We carried out observation, gathered evidence from care records and relevant discussions with staff in the home and at head office. We found an open and welcoming atmosphere where people had ample space to express themselves, move around the building and access to a garden that was adapted for wheelchair use.

There were long standing relationships between some of the people using the service and some staff members. We found that people’s diversity was respected and their need for friendships was met and social opportunities were promoted. We found that individual risk assessments took account of people’s capacity and ensured safety. Staff coordinated care planning with relatives and other professionals for the benefit of people.

Staff had been trained in safeguarding and demonstrated knowledge and skills in this area. We saw examples where potential harm was prevented.

Staff told us they felt supported and well trained for the job. We saw that they received training, supervision and peer support and annual appraisals.

There were systems and procedures for identifying and managing risk and we found examples of learning from incidents.

The two people at the home at the time of our visit were unable to speak with us. However, we saw that staff knew people well and had developed methods of communicating and understanding their wishes. Staff also encouraged people to indicate their wishes through behaviour, for example physically taking staff to the kitchen to show them what they wanted. We observed that people were respected and treated sensitively and as individuals by staff.

We saw that people had individual, personalised bedrooms. They were encouraged to be as independent as possible and to undertake daily activities such as shopping for groceries. People were encouraged to participate in leisure activities within and outside the home. At the time of our visit two people were attending day centre activities and we observed two people enjoying a music session with staff.

Staff were very supportive to people and there were arrangements in place to make sure the risk of confrontation between people was minimised and that they were kept safe. Staff had been well trained and knew how to recognise safeguarding situations and how to report concerns to the local authority safeguarding team.

11 Friars Close is a small service providing care and support to 4 people with learning disabilities in a residential road.

At the last inspection of 11 Friars Close on 16 January 2014 we found breaches of regulations related to: information not being available in ways the people living in the home understood; how decisions were made about some areas of people’s care and support and systems used to monitor quality not being effective. The provider wrote to us and told us what changes they would make to meet the relevant legal requirements. They told us they would achieve these changes by April 2014.

We undertook an inspection of 11 Friars Close on the 6, 7and 10 August 2015. We announced the inspection the day before we visited because we wanted to check there would be people and staff around when we visited. We found that some improvements had been made but that not all the actions detailed in the provider’s plan had taken place and the regulations were not all met.

This service needs to have a registered manager and there was one 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.

Staff were caring and knew people well but we found a number of issues relating to how people were supported.

There were quality assurance systems in place but these were not always effective.

Staff and managers had regular communication and meetings about the support people received and service issues. The service was not always fully focussed on fulfilling outcomes for people but was sometimes delivered to meet the needs of the service. For example, staffing rotas did not always reflect people’s preferences.

People were at risk of cross infection because soap was not available for staff and people in one toilet and equipment was not cleaned effectively.

People were protected from avoidable physical harm because risks had been assessed and guidance was available to staff. Staff knew how to identify most types of abuse and knew who they should report any concerns to.

People who could not make decisions about their own care and support had most appropriate decisions made on their behalf within the framework of the MCA 2005. However some decisions about restrictive practices had not been made clearly within the best interest framework. This meant there was a risk that some decisions being made about people’s care and support would not reflect the least restrictive option which is a principle of the Act. We have made a recommendation about identifying restrictive practices.

Staff were attentive to people’s immediate needs that could be easily met. People’s needs that required changes at a service level such as to staffing or to where someone lived were not assessed or responded to effectively.

Opportunities for people to develop their communication skills were not addressed consistently. Plans that had been introduced by a Speech and Language therapist had not been reviewed and followed effectively.

People’s care plans included information about personal preferences and provided individual detail about how people were supported day to day, but not all support was provided in ways that respected people’s autonomy or their religion. People were involved in activities during the day time. Evening activities were planned in advance as they required additional staff to work. Evening activities were, therefore, dependent on individual staff availability and were not a frequent occurrence.

Deprivation of Liberty Safeguards (DoLS) had been applied for people who needed their liberty to be restricted for them to live safely in the home.

People were supported by staff who had received appropriate training to do their jobs and cared about their welfare. Interactions between staff and those living in the home were gentle, familiar and kind.

People had access to appropriate healthcare for on going and emerging health needs. This included dental care, psychiatry and input from their general practice. They received their medicines safely and staff had liaised with health professionals to ensure they could receive them in a way that suited them individually.