This unannounced inspection took place on 13 and 19 October 2016.

Dunelm provides care, accommodation and support with personal care and nursing for up to 12 people with a learning disability. At the time of the inspection 10 people were using the service. It is purpose built and in a residential area close to public transport and other services. The ground floor is accessible for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available.

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 and associated Regulations about how the service is run.

Staff had completed Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training. Deprivation of Liberty Safeguards is where a person can be deprived of their liberties where it is deemed to be in their best interests or for their own safety. Staff were aware that on occasions this was necessary. We saw that this was thought to be necessary for some people living at the service to keep them safe. We have recommended that the occasional administration of covert medicines is reviewed to ensure that this option is in people’s best interest.

Staff were clear about their roles and responsibilities. The registered manager and staff team were committed to continuous improvement of the service and to improving people’s quality of life.

People who used the service had profound and complex learning, physical and health needs and their care was planned in partnership with their relatives. Relative felt any issues or concerns they raised would be dealt with by the registered manager. Their views were sought and valued.

The staff team worked closely with other professionals to ensure people were supported to receive the healthcare they needed. Systems were in place to ensure people received their prescribed medicines safely.

People were safe at the service. They were supported by kind, caring staff who treated them with respect. Systems were in place to minimise risk and to ensure that people were supported as safely as possible.

People were cared for by staff who had the necessary skills and knowledge to meet their assessed needs, preferences and choices and to provide an effective service. Staff received the support and training they needed to carry out their role and provide a safe service that met people’s needs.

People received a person centred service and were supported in activities they enjoyed both in the service and in the wider community.

The provider and the management team monitored the quality of service provided to ensure that people received a safe and effective service that met their needs.

People’s cultural and religious needs were respected and celebrated and their nutritional needs were met

People were protected by the provider’s recruitment process which ensured staff were suitable to work with people who need support.

People lived in a clean environment that was suitable for their needs.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found.

Is the service safe?

We met with people who used the service but due to the degree of their learning and

physical disabilities they were unable to give us any feedback about the quality of the

service. We spent time with them and observed how they were supported by the staff and we spoke to four people's relatives and a healthcare professional. We saw that staff treated people with respect and dignity. Relatives told us that they were very happy with the service provided. They said people were safe and well cared for. One relative said “they are definitely completely safe” A healthcare professional said "definitely a safe service. 100%.”

Staff had received training to ensure that they supported people safely. This included safeguarding vulnerable adults, moving and handling and administering medication. People’s files included risk assessments relevant to each individual. They indicated the risks to the person and how these could be minimised to ensure that they were supported as safely as possible.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) and staff had received training on this subject. Some applications had been made but formal DoLs had not been necessary.

Equipment needed to support people who used the service was well maintained and serviced regularly to ensure that it was safe and did not put people at risk.

Is the service effective?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One relative told us “they are good at monitoring people’s health and taking action when needed. If they feel there is a risk they contact the GP or take them to hospital.” Another said “they pay close attention to people’s welfare and are on the lookout for any changes. There was a stable staff team and they were able to recognise if people were unwell or in pain and took the necessary action.

The premises were purpose built and accessible for people with physical difficulties or who used a wheelchair.

People's care needs were assessed and detailed plans of care were developed from these. Staff had a good understanding of how to meet people's individual and assessed needs and of individual preferences. We saw that care plans were up to date and were reviewed with the person and their relatives. This meant that staff had current information and details to enable them to effectively meet people’s needs. A healthcare professional told us “there is a person centred approach.”

Is the service caring?

Relatives spoke highly of the care provided by the staff team. One relative told us “staff are super and seem happy.” Another said “staff put themselves out to do things.” We saw that staff supported people in a gentle, respectful and kind way. They offered people choices and talked to them about what was happening or what they needed to do.

People's preferences and diverse needs were recorded and care and support was provided in accordance with this. People's religious, cultural and social needs were identified and addressed. The service celebrated festivals from different religions and people were supported to wear traditional clothing and to listen to music from their own culture. People were also supported to be part of the wider community. They went out to eat, to the theatre and to places of interest.

Is the service responsive?

Care staff we spoke with were knowledgeable about the needs of people they supported and how to meet them. They told us how they identified if a person was unwell or unhappy and the action that they took if this occurred. A healthcare professional told us “staff all know people well and are good at giving me the information that I need. They always check things out and raise issues. People receive very good nursing care.”

We saw that care plans included information about people's likes, dislikes and preferences and were reviewed and updated at least every six months to ensure that they had correct and up to date information about people’s needs and how these should be met. The service was responsive to people’s changing condition and needs. They worked closely with other providers to ensure that these were met. For example the speech and language therapist was contacted when there were concerns about a person’s eating and drinking.

Is the service well led?

The service had a registered manager in place and there was a clear management structure. Staff told us that the home was well managed and they received the support and guidance that they needed to carry out their duties and to meet people’s needs. They told us that they had team meetings and also had an opportunity to have individual discussions with their supervisor. One member of staff told us “yes there are clear standards.”

Relatives told us that they were asked for their views about the service provided and that they met with the manager and the provider. This was during relatives meetings and also individual review meetings.

The provider had a number of different quality assurance systems in place to enable them to effectively monitor the quality of care provided. This included monthly visits by a senior manager and also health and safety, financial and quality audits. Any issues were documented for action and followed up.

We met with people who used the service but due to the degree of their learning and physical disabilities they were unable to give us any feedback about the quality of the service. We spent time with them and observed how they were supported by the staff and we spoke to two people’s relatives and a visiting healthcare professional. Relatives told us that they were very happy with the service provided. They said people were safe and well cared for. One relative said “we are really pleased with the care that she gets.” Another said “no problems at all. The staff are very good and people are very well cared for.”

People were treated with respect and their health and welfare needs were met. A relative said “they look after her health needs well.” The healthcare professional told us “the staff work closely with health colleagues and know how to get other professionals involved when needed.”

We saw that people were supported to have a nutritious diet and to eat and drink. There were systems in place to ensure that people received their prescribed medication appropriately.

Systems were also in place to ensure that people were safeguarded from abuse and that any restrictions placed on them were in their best interests.

We spoke with people who use the service but due to the degree of their learning and physical disabilities they were unable to give us feedback about the quality of the service. We spent time with them and observed how they were supported by the staff team and we spoke with three people’s relatives and two healthcare professionals. Relatives told us that they were very happy with the service provided. They said that people were safe and well cared for. Comments included “I have always been happy with the home. I trust them implicitly”, “the care is fantastic and the staff are wonderful and caring” and “Dunelm is wonderful. They are always looked after well.”

People were treated with respect and their care and welfare needs were met. Healthcare professionals told us that people were very well cared for and that any actions they recommended were carried out. People were supported to use community facilities. There was a variety of training available and staff had received the training needed to meet people’s complex needs. The provider monitored the quality of the service to ensure that it was safe and met people’s needs. However although there were systems in place to safeguard people from abuse there were not adequate systems in place to ensure that controls or restraint placed on people were not excessive and were reviewed regularly.