DRS Care Home

DRS Care Home is a residential care home providing accommodation and personal care to up to 4 people with a learning disability, people with mental health needs and /or autistic people. At the time of the inspection 4 people were living at the home. The home is a terraced house in a residential area, which is over 2 floors with access to a garden area. People have access to a communal kitchen, lounge and dining room area.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People's experience of using this service and what we found

Right Support:

Staff supported people to access health and social care support in the community. They supported people being involved in maintaining their own health and wellbeing where possible. Staff communicated with people in ways that met their needs. The service gave people care and support in a safe environment that met their sensory and physical needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

People's needs were appropriately assessed before they moved to the service. The service worked together with healthcare professionals and relatives to ensure people's needs could be met. People were supported with nutrition and hydration. Care was person-centred and promoted people's dignity, privacy and human rights. Staff understood how to protect people from poor care and abuse. Staff were appropriately trained on how to recognise and report abuse and they knew how to report safeguarding concerns. Relatives told us their love ones were safe living at the service. Care records contained risk assessments with clear guidance for staff to follow. Medicines were managed safely. Staff were recruited safely. The premises were clean and well maintained.

Right Culture:

The registered manager promoted a person-centred environment and people experienced good outcomes. Relatives spoke positively about the management team and staff. People received good quality care, and support because trained staff and specialists could meet their needs and wishes.

Staff understood people’s needs in relation to their strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This enabled people to receive compassionate and empowering care that was tailored to their needs. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

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

Rating at last inspection

The last rating for this service was good (published 10 January 2020)

Why we inspected

The inspection was prompted in part due to concerns received about the provider in relation to the management of the service, staffing levels, recruitment and medicines management. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for DRS Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

DRS Care Home is a terraced house, on two floors with access to an outside area at the back. There were two 'move on' supported living units located in the garden area which have a separate entrance. Support to the people living in these is provided by another DRS scheme locally. This inspection relates to the residential care service only.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People's experience of using this service and what we found

People trusted the staff and felt safe with them. The management and staff had assessed potential risks to their safety. Ways to reduce these risks had been explored and were being followed appropriately.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination. Staff knew what to look out for that might indicate a person was being abused.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences. Staff and management made sure no one was disadvantaged because of their age, gender, sexual orientation, disability or culture. Staff understood the importance of upholding and respecting people's diversity. Staff challenged discriminatory practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood the way people expressed their views and the service made sure no one was disadvantaged because of the different ways people communicated.

Everyone had an individual plan of care which was reviewed on a regular basis.

All staff had clear roles and responsibilities and understood the values of the service.

Staff had been trained in the management of medicines and suitable policies and systems were in place to ensure people’s medicines were managed safely.

Staff were positive about working for the organisation and told us they appreciated the support and encouragement they received from the registered manager.

People who used the service, their relatives, staff and outside healthcare professionals had regular opportunities to comment on service provision and made suggestions regarding quality improvements.

People knew how to complain if they needed to and were asked if they were satisfied and happy with the service on a regular basis. Everyone working at the home understood the need to be open and honest if mistakes were made.

The management team worked in partnership with other organisations to support care provision, service development and joined-up care.

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

Rating at last inspection

The last rating for this service was good (published 15 June 2017).

Why we inspected

This was a planned inspection based on our agreed inspection frequencies for newly registered services. As a result of this inspection the service has been rated 'Good'.

Follow up

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

The service is located in a terraced house, on two floors with access to an outside area at the back. There were two ‘move on’ supported living units located in the garden area. Support to the people living in these is provided by another DRS scheme locally. This inspection relates to the residential care service only.

At our last inspection in January 2016 the service was meeting all of the regulations, but had an overall rating of Requires Improvement.

DRS Care Home had a registered manager at the service. 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.

We saw staff were kind and caring to people living at the service, and this was confirmed by family members.

The staff demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

Care plans were up to date and showed people’s strengths as well as needs. They were person centred and gave detailed information on how exactly to support people. Risk assessments were in place and covered the majority of risks identified.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people with complex needs in the home. Staff told us they were well supported by the registered manager and could contribute their views to the way in which care was provided and the service was run. We could see regular supervision and training took place.

Safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Medicines were stored and managed safely. People received their medicines as prescribed and on time.

A health and social care colleague told us the service worked closely with them to meet people’s needs and manage their behaviours.

People participated in a range of activities in the local community.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The service was working within the principles of the MCA 2005 and DoLS.

The registered manager and deputy manager carried out quality assurance processes to ensure people received a good service and they showed they were continually working to improve the service.

The service was clean throughout, and well maintained. Essential services, for example, gas, electricity and fire safety equipment were regularly maintained. Fire drills took place regularly.

At the time of our inspection there were three people living at the service.

The service was located in a terraced house, on two floors with access to an outside area at the back. There were two ‘move on’ supported living flats located in the garden area. Support to the people living in these was provided by another DRS scheme locally. This inspection relates to the residential care service only.

At our last inspection in August 2014 the service was meeting all of the regulations we looked at.

DRS Care Home had a registered manager at the service. 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.

People were positive about the service and the staff who supported them. People told us they liked the staff that supported them and that they were treated with dignity and kindness.

Staff were fully aware of people’s needs and these were carefully documented in care plans. Care plans were individualised and reflected people’s choices, likes and dislikes, and arrangements were in place to ensure that these were responded to. Care plans provided detailed information on people’s health needs which were closely monitored.

People were supported to maintain good health through regular access to healthcare professionals, such as mental health professionals and GPs. Risk assessments had been carried out and these contained guidance for staff on protecting people. Health and social care professionals told us staff responded quickly to changes in people’s needs if they were physically or mentally unwell, and this was confirmed by the records.

Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm.

The service was working within the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People had their medicines managed safely. People received their medicines as prescribed and on time. Storage and management of medicines was well managed.

The premises were clean and the building was in a good state of repair. There was evidence of regular servicing of essential facilities such as gas, electricity and fire equipment. Fire drills and checks of the system took place on a regular basis.

Staff had been carefully recruited. Appropriate references and Disclosure and Barring Service checks were undertaken before staff began work to ensure that staff were safe to work with people. Regular supervision took place with staff. However the registered manager was allowing some staff to work excessive hours at the service and we were concerned about the impact this might have on their working practice and wellbeing.

We have made a recommendation in relation to staff training.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. We carried out this inspection to check on compliance with Outcome 2 (Consent) following a compliance action made at the previous inspection relating to the care home, and also looked at the care provided to people in their own homes under Outcome 21.

At the time of the inspection there were four people living in the home. We spoke with two of them, and two were out during the inspection visit. The provider also provides personal care to people in their own homes from this address. At the time of the inspection we were told that they were only providing personal care to one person, and they stopped providing this shortly after the inspection. They were also providing support (without personal care) to a number of people in a supported living service.

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

Is the service safe?

People told us that they felt safe at the care home and when supported within their own homes. Staff had undertaken safeguarding adults training and understood their role in safeguarding the people they supported.

Recruitment records for staff indicated that appropriate checks had been undertaken to ensure their fitness to work with vulnerable people.

Is the service effective?

People told us that their care and support needs were met effectively. Comments included 'It's really nice over here,' 'I really like it,' and 'At the moment everything's fine.' Staff received appropriate support and supervision to enable them to deliver care and support to people to an appropriate standard.

Is the service caring?

People we spoke with told us that staff were respectful, caring and responsive to their needs. They said 'They treat you with respect,' and 'Staff always ask permission before doing anything.' We also observed a good rapport between staff and people living in the supported living service.

People's preferences, interests, aspirations and diverse needs had been recorded to ensure that care and support were provided in accordance with their wishes.

Is the service responsive?

We saw that staff had identified people's cultural and religious needs, and people were supported to attend places of worship and have cultural foods. One person living in the home advised that they were being supported to develop daily living skills to move onto more independent accommodation.

There were records to demonstrate that people's consent had been obtained in relation to any restrictions placed upon them within the home, and that a best interest decision had been made when they were unable to do so.

Is the service well-led?

People living in the care home and those receiving support in their own homes spoke positively about the service and management.

Staff told us they were clear about their roles and responsibilities. Staff we spoke with showed that they understood the needs of individual people they cared for.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People told us that they felt safe at the home. Staff had undertaken safeguarding training and understood their role in safeguarding the people they supported. Accidents and incidents were recorded appropriately, and the home environment was safe, clean and hygienic.

Recruitment records for staff indicated that appropriate checks had been undertaken to ensure their fitness to work with vulnerable people.

Is the service effective?

People told us that their care and support needs were met effectively. Comments included 'I get my tablets on time,' and 'There are enough staff on.' Their health and care needs were assessed with them, and they were involved in writing their care plans. Care plans and person centred plans were reviewed regularly to ensure that staff met people's needs consistently.

Staff received appropriate support and supervision to enable them to deliver care and support to people to an appropriate standard.

Is the service caring?

People we spoke with told us that staff were caring and responsive to their needs and treated them with respect. One person told us 'They respect your privacy.' Another person said that although they were struggling with their mental health,'..the staff are very nice.' We observed staff showing patience and giving encouragement when supporting people. People's preferences, interests, aspirations and diverse needs had been recorded to ensure that care and support were provided in accordance with their wishes.

People using the service, and visitors to the home had completed an annual satisfaction survey indicating that they were happy with the support provided at the home.

Is the service responsive?

We saw that staff had identified people's cultural and religious needs, and people were supported to attend places of worship and have cultural foods. Some of the people living at the home advised that they were being supported to develop daily living skills to move onto more independent accommodation.

However there were insufficient records to demonstrate that people's consent had been obtained in relation to any restrictions placed upon them within the home, or that their consent was reviewed regularly. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in planning their care.

Is the service well-led?

People living at the home spoke positively about the home's manager. One person told us 'He's one of the best managers I've had, and I've been in many places.'

We reviewed several monthly audits that took place and a recent quality assurance survey. Staff told us they were clear about their roles and responsibilities. Staff we spoke with showed that they understood the needs of individual people they cared for.

People had their needs assessed by staff with suitable skills and expertise, this included social workers and other professionals. People who used the service told us "I liked the service."

We found that peoples care needs were met by staff in accordance with their individual care plans. Staff had information to guide them in managing any potential risks to people's safety and well-being.

Staff had training in relation to safeguarding vulnerable adults and had access to information to guide and support them in this area. Staff told us they "felt supported in the workplace and were confident in the management arrangements."

People received their medicines in accordance with their prescribed needs. There were effective arrangements in place to manage the different types of medicines used by the people.

Staff records and other records relevant to the management of the services were accurate and fit for purpose. We saw there were systems in place for regular safety checks and service audits. These included confirmation they were current and up to date.

'I like living here. It is good. The thing is, the staff are really caring.'

'The staff are okay. They will talk to me about things.'

'[It is] good. Good.'

We found that people were able to express their opinions and were involved in choices about their care.

The home was clean and there were appropriate procedures in place to ensure cleanliness was maintained.

The staff working at the home had appropriate checks undertaken on them prior to working at the home.

There was an appropriate complaints procedure in place and people using the service had been given information on how to complain if they wanted to.