The Dovecote Residential Care Home provides accommodation and care for up to 18 people with a learning disability. The home is located in Pleasley, Nottinghamshire. On the day of our inspection 17 people were living at the home. At the last inspection, in November 2015, the service was rated Good. At this inspection we found that the service remained Good.

People continued to receive safe care. Staff understood how to keep people safe and were appropriately recruited. There were enough staff to meet people’s needs and people received their prescribed medicines safely.

People were supported by staff who received appropriate training and supervision. People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way. People were supported to maintain good health and nutrition.

People were cared for and supported by staff who respected them as individuals, staff had positive relationships with people and respected their privacy and dignity. People and their relatives were involved in planning and reviewing their own care.

People received individualised care and were provided with meaningful interaction and activities. People felt confident to make a complaint and were confident these would be responded to.

The service had a positive atmosphere. The registered manager and service manager were committed to delivering a good quality service and had effective systems in place to promote and encourage this.

We carried out an unannounced inspection of this service on 4 November 2015. The Dovecote Residential Care Home is registered to provide accommodation and personal care for up to 18 people with a learning disability. The home is located in Pleasley, Nottinghamshire. On the day of our inspection 14 people were using the service.

The service had a registered manager in place at the time of our inspection. 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 last inspection on 13 August 2014, we found six breaches of Regulations. After the inspection, the provider wrote to us to say what action they would take to meet the legal requirements in relation to the breaches. On this inspection, we found that the provider had taken the required action to ensure that people were safe and their needs were met.

People felt safe in the service and the registered manager had shared information with external agencies when needed. This meant there were systems in place to protect people from the risk of abuse.

Medicines were managed safely and people received their medicines as prescribed. Staffing levels were sufficient to support people’s needs and people received care and support when required.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support.

People were supported to make decisions and where there was a lack of capacity to make certain decisions; people were protected under the Mental Capacity Act 2005.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

Staff valued people and encouraged people to achieve their goals and aspirations. People’s independence and choice was considered and support was delivered in a relaxed and supportive manner.

People lived in an open and inclusive environment and were supported to develop their daily living skills. People knew who to speak to if they had concerns and were confident that these would be responded to.

People were involved in giving their views on how the service was run and involved in decisions about the service. The systems in place to monitor the quality of the service provided were effective.

The inspection team who carried out this inspection consisted of three inspectors to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people. We spoke with six people who used the service, members of the management team and two staff. We also looked at some of the records held at the home, which included people’s support care plans. We also observed the support people received from staff.

There was a registered manager who was available throughout our inspection

Is the service safe?

On the day of our inspection people told us they felt safe and felt the staff would always promote their health and wellbeing.

Members of staff told us they felt they could report any concerns or suspicion of abuse to the management team. They were able to give a good account of the actions they would take if they suspected abuse was happening.

Staff told us they would always support a person if they wished to make a complaint or report a concern and all felt that the registered manager would listen and address any complaints effectively.

We found that some staff training designed to aid staff in promoting people’s safety such as managing challenging behaviour and epilepsy awareness was out of date. We also found that a system to identify the member of staff who could be called upon to administer first aid in an emergency situation had not been followed. These issues could compromise the staff’s ability to respond to people’s needs appropriately, which could compromise their safety if left unaddressed.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. We found that one person had a DoLs order in place. The registered manager also told us that they were in the process of facilitating stage two mental capacity assessments for all of the people who were residing at the home with the assistance of representatives from social services. This is to ensure that each person’s rights are protected and care is provided in people’s best interests.

The provider made us aware of an episode of financial abuse in July 2014 which was identified through their internal audit of people’s financial records. Following the identification of the financial irregularities we found the provider had referred these issues to the appropriate local authority’s safeguarding adult’s team. The police had initiated an investigation into this matter and the provider was awaiting the outcome of the investigation. The provider had reimbursed people’s money as required and they were liaising with the local authority to amend their policies and procedures. We will continue to monitor this element of service provision to ensure the required improvements are made.

We saw that an on-call rota system was in place to ensure a member of the management team would be available at all times should staff require guidance in an emergency situation.

Is the service effective?

Whilst we found that the staff we spoke with had a good understanding of people’s individual preferences in relation to care delivery, people’s care plans required further developments as they did not, in all instances, provide sufficient information to inform all staff.

We found that some risks had been identified and assessed in relation to aspects of people’s care and support but not all. For example, the lack of a care plan to manage a person susceptibility to pressure ulcer formation and the lack of detail in another person’s care plan relating to management of diabetes.

Is the service caring?

Throughout the day of our inspection we observed staff asking people to make informed choices in relation to their food preferences and what activities they wanted to take part in.

We found staff responded to people in a caring and respectful manner. We saw there were staff available to give assistance where needed and supported people’s independence at all times.

Is the service responsive?

We found people were asked about their opinion of service provision within residents’ meetings. We also established that resident’s questionnaires would be distributed to people in September 2014. The registered manager told us the results of the consultation process would be made available to people residing at the home and their relatives.

We were informed by the manager that two informal complaints had been made since the home was registered in December 2013. We were not able to review the management of the complaints therefore we could not determine if they had been investigated and responded to appropriately.

Is the service well-led?

Whilst staff said they felt the manager had improved the quality of the service provision they also felt that an increased managerial presence would enhance the quality of service provision. They believed the increased presence would allow the registered manager to monitor the quality of the service more closely which they felt could have benefited the service.

We established, through an examination of records and conversations with the registered manager, that further developments were required to ensure a robust auditing system was in place to fully assess and monitor the quality of service provision. The manager told us they had designated this responsibly to an alternative member of staff but on reflection they were not confident that auditing process had been performed effectively.

We found that the auditing process had not ensured the staff training matrix was up to date as it did not reflect the training status of all the staff employed at the home. We also found the auditing processes had not identified that staff supervisions were inconsistent.

We found it difficult to determine if people had received additional funding for one to one support as records were not maintained to demonstrate how the commissioned additional support hours were provided. We also found that staff were not clear on what constituted one to one support and how it was to be recorded.