About the service: The Dell is a service for up to 48 people who have a learning disability and/or Autism. Accommodation is provided across eight bungalows on one site. At the time of this inspection 25 people were living at the service. There is also a central office block used for catering and some day service activities.

People’s experience of using this service:

People did not always receive a service that provided them with safe, effective and high-quality care.

The environment was not always well maintained and repairs were not actioned in a timely manner.

The management of risk and medicines was ineffective and placed people at risk of harm.

The service was not always well led. There was a lack of effective quality assurance processes in place

People were supported to have maximum choice and control of their lives and staff (did not support) supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received support from staff who were kind and treated them with respect.

People were supported to maintain a healthy and balanced diet.

People had support plans however these were often out of date and did not reflect the care and support they needed.

The Dell has not been operated and developed in line with all the values that underpin the Registering the Right Support and other best practice guidance. The Dell was designed, built and registered many years before this guidance was published. The outcomes for people did not fully reflect the principles and values of Registering the Right Support because the model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a learning disability and/or Autism should be operated to meet their needs.

Rating at last inspection: The rating at the last inspection was ‘Good’. The last report for The Dell was published on 13 April 2017.

Why we inspected: This inspection was brought forward as we had received some concerns about environmental standards at The Dell.

Follow up: We will continue to monitor the service through the information we receive.

The Dell provides accommodation and personal care for up to 48 people who have a learning disability. People who use the service may also have a physical disability. At the time of our inspection 33 people were using the service. The accommodation was in small individual bungalows on the one site.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 associate Regulations about how the service is run.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLs and associated Codes of Practice.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were sufficient numbers of care staff on shift with the correct skills and knowledge. There were appropriate arrangements in place for medicines to be stored and administered safely.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times. People and their relatives were involved in making decisions about their care and support.

Care plans were individual and contained information about how people preferred to communicate and their ability to make decisions.

People were encouraged to take part in activities that they enjoyed, and were supported to keep in contact with family members. When needed, they were supported to see health professionals and referrals were put through to ensure they had the appropriate care and treatment.

Relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service.

The management team had systems in place to monitor the quality and safety of the service provided.