Shaftesbury Dolphin Court

Dolphin Court is a care home providing personal care and accommodation for up to fifteen people with a learning disability, physical disability and/or acquired brain injury. The service does not provide nursing care. At the time of inspection there were 14 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection the service were providing personal care to 11 people.

People’s experience of using this service

Feedback we received from people and professionals about the service was positive. People enjoyed living at the service were in control of their day to day lives. The vision and values of the service which were shared by all staff reflected best practice principles ensuring people received support to live full and independent lives, challenging the barriers around supporting people with disabilities.

Staff knew how to protect people from the risk of harm. Risks to people had been assessed and staff knew what to do to keep people safe. There were sufficient staff employed to meet people's needs who had been safely recruited.

Safe systems for the management of medicines were in place. Only staff who had been trained and assessed as competent administered medicines. The service practiced the principles of STOMP which aims to stop the overuse of anti-psychotic medication for people with learning disabilities or mental health conditions. The service demonstrated a 'learning culture' where accident and errors were reflected upon to improve practice.

A range of support mechanisms were in place including the provision of regular training, supervision and observations of staff to practice to ensure staff had the skills and knowledge to support people effectively.

People were supported to have enough to eat and drink that met their needs and preferences. Staff supported people to access healthcare treatment and advice as needed to help maintain people's health and wellbeing. The home environment was suitable for people's needs. Rooms had been personalised to reflect people's tastes.

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.

Staff were kind and caring and had formed positive relationships with people. People were listened to and included in all aspects of their care and support planning. Staff treated people with dignity and respect and protected their privacy. Independence was encouraged and promoted.

The service adopted a person-centred approach placing people at the heart of the service. People's care and support plans were written in a personalised way that reflected each person's individual needs and preferences.

There were systems and policies in place to respond to complaints. If people had particular needs and preferences around end of life care, these were known and recorded. Staff showed a good awareness of people's wishes.

The culture of the service was open and inclusive and the service benefitted from good leadership. Staff enjoyed working at the service and felt well supported. Quality assurance systems were in place to monitor the safety and quality of the service and improvements were driven by engagement with people whose views were listened to and acted upon.

Rating at last inspection: Good. (Last report published April 2017).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service.

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

Dolphin Court provides personal care and accommodation for up to seventeen people who are living with a learning disability, physical disability and/or acquired brain injury. The majority of people living at the service were independent and required limited support with personal care however there was a minority of individuals with more complex needs requiring more support than others. There is a large communal room on the ground floor with easy access to an enclosed garden area with summer house. There is a lift to bedrooms on the first and second floors.

The service had 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 2008 and associated Regulations about how the service is run.

Since our last focused inspection on 18 May 2016, the service had sustained the initial, immediate improvements that had been made. Further improvements had been identified and were being driven by the registered manager, such as the consistency of staff recording information. However, quality assurance systems were in place and being used effectively by the registered manager and provider to monitor the service provided to people. Effective leadership was clearly present within the service to drive the improvements identified by the systems.

There were sufficient members of staff working within the service which meant people’s individual needs were consistently met within reasonable time frames. People’s medicines were managed appropriately and concerns were responded to by management. The service worked with local authorities and professionals to ensure best practice. A robust recruitment process was in place and staff were employed upon completion of appropriate checks.

Staff appraisals had not been completed, however staff were provided with individual supervision, training and staff meetings to facilitate support form management. The registered manager confirmed that annual appraisals were planned and would be effectively implemented. People were supported by staff to access healthcare services and attend health appointments. Support plans were updated with professional’s guidance to help staff support people safely. People’s dietary requirements were delivered safely and people were given choice which staff respected.

Management and staff understood their responsibilities and the framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Decisions were made in people’s best interests with the involvement of appropriate persons, which ensured people’s rights were protected and that freedom was not being inappropriately restricted.

Staff and management were caring towards people and relatives. Staff respected people’s privacy and dignity was valued. Care continued to be provided in a way that intended to promote people’s independence and wellbeing for the majority of people.

People were supported to carry out their own daily interests independently or achieve them with the assistance of staff. People who had decreased independence were supported by staff to be involved in activities, if they chose to. A complaints system was in place and people knew how to use it.

Dolphin Court provides personal care and accommodation for up to seventeen people who are living with a disability. The majority of people living at the service were independent and required limited support with personal care however there was a minority of individuals with more complex needs requiring more support than others.

A new manager had been appointed on 4 April 2016 and was in the process of becoming registered with the commission. 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 looked at records in respect of people’s care and treatment and found that improvements had been made. Records regarding people’s nutrition, weight, pressure relieving equipment and infection control were being maintained and audited.

Since our last inspection, although improvements were still ongoing systems had been put in place to support quality assurance processes and improve the care people received.

Dolphin Court provides personal care and accommodation for up to seventeen people who are living with a disability. The majority of people living at the service were independent and required limited support with personal care however there was a minority of individuals with more complex needs requiring more support than others.

The service does not currently have a registered manager however recruitment processes were underway to appoint a registered manager. The service is required to have 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.

The service needed to improve their quality assurance systems. Although some systems were in place, effective leadership was needed within the service to drive the improvements identified by the systems. The deputy manager was new to managing the service and required more support from the provider in the interim period whilst a new registered manager was being recruited.

Accurate records in respect of people’s care and treatment had not been maintained for people with more complex needs to mitigate risks to their health.

Insufficient members of staff meant people’s individual needs could not be consistently met within reasonable time frames. In general people were supported to carry out their own daily interests independently or achieve them with the assistance of staff, if requested. However there was a lack of activities for people with more complex needs.

Management and staff understood their responsibilities and the framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Action plans had been created which identified areas of improvement. However, the lack of management and direction had led to a lack of assurance that appropriate measures were being actioned to protect people’s rights and that freedom was not being inappropriately restricted.

Staff supported people to ensure they received access to healthcare services when required. Staff also worked with a range of health professionals, such as speech and language therapists and GPs, to implement care and support plans.

Qualified staff supported people satisfactorily with the administration of their medications. A robust recruitment process was in place and staff were employed upon completion of appropriate checks.

Staff were respectful and caring towards people ensuring privacy and dignity was valued. Care was provided in a way that intended to promote people’s independence and wellbeing for the majority of people.

We saw that people's care needs were assessed and planned for with any risks associated with their care being minimised as far as possible. The service was caring, supportive and responsive to people's changing needs. Staff sought support from other professionals or agencies when needed.

We saw that people were supported to follow their own interests. Opportunities for activity and occupation were available.

People told us that they enjoyed the variety and choice of food available at Dolphin Court. We found that people's nutritional needs were assessed and monitored to ensure their on-going wellbeing.

The service was kept clean and provided a hygienic place for people to live.

We found that the service had suitable systems in place to listen to people's views and monitor quality. This helped to ensure an effective, good quality and safe service.

Suitable records relating to people's care and the running of the service were maintained.

Another person spoken with was very complimentary about the service. They told us that, when they first came out of hospital, Dolphin Court and the staff had been a 'God send'. They told us that they had received the right amount of support to help them to regain their independence, so much so that, they were now looking to move on into their own flat in the community.

We found that records relating to people who used the service were not being properly completed to provide an accurate reflection of their needs. Records relating to people's safety and wellbeing were not readily accessible. The environment and equipment provided was fit for purpose. Staff had received training and spoke knowledgably about the people they provided care and support to.