We inspected Saint John of God Hospitaller Services - 1-2 Dalby View on 1, 5 and 15 November 2018. The inspection was unannounced, which meant the staff and provider did not know we would be visiting.

Saint John of God Hospitaller Services - 1-2 Dalby View 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 service is registered to accommodate a maximum number of eight people with a learning disability. There are two bungalows (four people in each) situated on the same site. At the time of the inspection there were eight people who used the service.

The care service 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. Registering the Right Support CQC policy.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was on leave at the time of our inspection. However, the deputy operations manager was present and supported us with this inspection.

At our last inspection in December 2016 we rated the service as good. At this inspection we found deterioration and rated the service as requires improvement. This is the first time the service has been rated Requires Improvement.

At our last inspection of the service in December 2016 we found those people lacking capacity did not have decision specific mental capacity assessments or best interest decisions formally recorded. At this inspection we found no improvement had been made. It was our judgement, through speaking with staff, that decisions such as accessing health professionals and taking medicines had been made in people’s best interest, but there was no formal recording of this.

The home environment needed refurbishment and some furniture such as wardrobes and drawers needed replacement. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

We found some care plans were confusing or contained insufficient information to ensure people’s care needs were met. Care records contained numerous generic risk assessments which were not needed and made care records difficult to navigate. Care records provided information to staff on support people needed when getting up on a morning and when they were retiring to bed. However, there was limited information about how people liked to spend their day and the support they required from staff to do this.

Quality monitoring was undertaken, however, we found some of this to be ineffective as this did not identify the areas of concern that we found at this inspection.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Medicines were managed safely with an effective system in place. Staff competencies around administering medicines were regularly checked.

There were enough staff on duty to meet people’s needs. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

The home was clean and tidy. Appropriate personal protective equipment and hand washing facilities were available. Staff had completed infection control training.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A tr

We inspected Saint John of God Hospitaller Services – 1-2 Dalby View on 9 December 2016. This was an unannounced inspection, which meant that staff and the registered provider did not know we would be visiting. When we last inspected the service in January 2015 we found that the registered provider was meeting the legal requirements in the areas we looked at.

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

Dalby View is registered to provide care and support to people in two separate bungalows. The service provides care, support and accommodation to eight adults who have learning disabilities and / or physical disabilities. The service is close to all local amenities. At the time of the inspection there were eight people using the service.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People who used the service told us that staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We did note there wasn’t a cyclical routine for the testing of fire call points which meant some call points had not been tested as much as others. The registered manager contacted us after the inspection to confirm they had taken action to address this.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as health, behaviour that challenged, falls, burns and scalds. This enabled staff to have the guidance they needed to help people to remain safe

There were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with people who used the service.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

Staff had received induction training and shadowed other more experienced staff when they were first recruited. The majority of staff had completed training in food hygiene, fire awareness, emergency first aid, moving and handling, safe handling of medicines and safeguarding. There were some gaps in training for behaviour that challenges, Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. We were informed that this training would take place early in the New Year.

Staff had an understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards and acted in the best interest of people they supported, however at the time of the inspection, processes had not been followed to formally record this. Information was supplied to us after the inspection to confirm that staff at the service had commenced this process.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appo

We inspected Saint John of God Hospitaller Services – 1-2 Dalby View on 29 January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Dalby View is an eight bedded residential service, which is split across two separate bungalows. The service provides care support and accommodation to eight adults who have learning disabilities and / or physical disabilities. The service is close to all local amenities.

The home 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.

At the time of the inspection the registered manager was spending some time during the week away from the home. They were providing management support to another service in the organisation. In the interim the deputy manager was acting as manager when the registered manager was away from the service.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as health, behaviour that challenged, falls, burns and scalds. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervision on a regular basis and an annual appraisal.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People and relatives told us that there were enough staff on duty to meet people’s needs. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. However, staff had not undertaken nutritional screening to identify specific risks to people’s nutrition.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that people had hospital passports. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.

Assessments were undertaken to identify people’s care, health and support needs as well as any risks to people who used the service and others. Plans were in place to reduce the risks identified. Support plans were developed with people who used the service and relatives to identify how they wanted to be supported.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that there was a plentiful supply of activities and outings and that people who used the service went on holidays. Staff encouraged and supported people to access activities within the community.

The provider had a system in place for responding to people’s concerns and complaints. People and relatives told us they knew how to complain and felt confident that staff would respond and take action to support them. People and relatives we spoke with did not raise any complaints or concerns about the service.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the home had an open, inclusive and positive culture.

We spoke with six of the seven people who used the service and met two relatives. The people we spoke with were extremely satisfied with the service and very complimentary about the staff who supported them. They felt the staff understood their needs and could readily make sure they lived a stimulating life. People told us about the holidays they go on; the trips they go on to the cinemas, the bowling alley and local entertainment; and how staff make sure their care needs are met. People felt the home was run like a large family unit.

One person told us, “The staff are very, very good. If you ask for anything to be done for you, then they do it.”. People also said, “It is wonderful here” and “Staff really care about us.”

We found that people's care was planned and delivered in line with their needs. The staff were very knowledgeable about people’s care needs and how to meet them. We noted that the staff team had been very stable and all of the staff had been in post for a number of years. We found that the manager made sure the home provided effective care and encouraged staff development.

The home was well-maintained and the provider had an on-going programme of redecoration which ensured it was kept to a high standard,

We found that effective procedures were in place should people wish to complain.

During the visit, we spoke with seven of the eight people who used the service and two relatives. During this routine visit we asked people about the choices on offer; what the care was like; and what people thought about the staff. People told us that they really liked living at the home and thought the staff were good at their jobs. People said, ‘’I love it here.”,‘‘I go with staff in the car and get things I like’’ and ‘’I go to college and have been doing work in the head office, eventually I would like to live more independently but am not ready yet. Staff have really helped me to learn the skills I would need so I can cook, budget and that’’ and ‘’The staff are very good, they are really friendly and funny.”

People told us that the service was run in ways that made them feel part of a family. We were told that all the staff were competent and supportive. People said, ‘’The staff have supported me to learn the skills I need to live on my own’’, ‘’I’m taking it at a steady pace and at the minute doing college courses but want to look for employment soon’’ and ‘’The staff sit down with me and go through my plans to see how we can make these happen.”

One of the relatives did raise concerns that people’s personal care was not always attended to in a timely fashion. We looked at this issue during the visit and found that staff understood all care needs people had. Staff had ensured people were able to were regularly offered the opportunity to attend to their personal care needs. We found that one person’s family had requested to attend to some aspects of this individual needs and staffed respected this request so at times the person waited for them to visit. Also we noted one person needed a shave but an exacerbation in their health condition meant staff had been unable to shave them that day.