Dorandene - Care Home Learning Disabilities

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

People were generally treated with kindness, empathy and compassion. Staff did not always know how to support people to do what they enjoyed and did not promote people’s independence, choice and control. However, staff we saw the management team’s plans to encourage people’s independence by coaching and training staff. Further work was required to embed this within the service. The provider had implemented plans for supporting workforce development and retention in relation to upskilling staff, equality, diversity and inclusion, and supporting staff wellbeing. Our findings showed that the service was not meeting the statutory guidance RSRCRC because people were not always empowered to be as independent as possible. However, the management team provided support and coaching in order to address this area and we saw that the process had already started.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were generally treated with kindness, empathy and compassion by staff, however, we observed one instance of staff not recognising that they were not acknowledging a person’s right to choose whether they wished for their mouth to be wiped and another instance where staff discussed personal care needs in the presence of other people. The management team intervened and addressed this with the staff member. We observed other examples of staff holding people’s hands when they appeared distressed and taking the time with people to offer a distraction.

Staff told us they knew how to uphold people’s right to dignity, respect and privacy. Whilst we identified the example above, staff were aware of the steps they should take to maintain people’s dignity, respect and privacy.

We received mixed feedback from partners in relation to the way staff approached people with some commenting that staff had always appeared kind, and others commented that the improvements were too slow. We discussed this with the provider who gave us assurances that they were overseeing the service directly to ensure consistent working with partners.

Whilst we identified areas of improvement, staff appeared to take an interest in people and how to reassure them. Staff generally provided kind care and were available when people appeared to be distressed. The management team intervened on several occasions and showed us that they were coaching staff to understand all of the principles of RSRCRC.

People were generally treated as individuals and staff knew their needs. However, staff did not always take into account people’s ability and preferences. This was not in line with RSRCRC. However, the management team was present and addressed these with the relevant staff member. Where there were concerns with the way staff interacted with people, the management team had already taken formal steps prior to our site visit.

Staff and leaders understood how to treat people as individuals and generally followed this. Where staff did not follow this, management took action. Staff were able to tell us how they would treat people as individuals. Staff explained how they would ensure that people are treated as individuals such as ensuring social, religious and cultural choices are met.

There was a generally positive atmosphere at the service and the impact of the new management team was apparent. Where staff were unsure at times, managers were available to support them by coaching and providing training. The majority of staff appeared to know people well and were able to anticipate when people may need support.

People’s care plans reflected their individual needs and included information such as people’s cultural, social and religious needs and preferences. Staff had tried to find out more about people’s religious needs and whether people practised them. People’s care plans included information on their preferred communication method. We saw there was work ongoing to ensure pictorial aids were always available. 90% of staff had completed communication training and there were plans in place for all staff to complete this as a priority.

There had been an improvement from the previous inspection in relation to people being meaningfully engaged in activities. The activities in the service required further work but we saw people going out and undertaking activities they were interested in.

Staff told us they knew how to promote independent, choice and control. They told us that they knew people could make unwise decisions and the steps they took on a day-to-day basis to promote independence. Despite telling us, staff were observed not always following these guidelines in line with national guidance such as RSRCRC. The management team had discussed this with staff and showed us evidence of group supervisions.

We observed staff generally promoting choice and independence during the site visits. However, we observed one occasion when a member of staff completed a task despite the person being able to complete the task independently. The management team immediately addressed this and we did not observe any further instances. On another occasion, a member of staff tried to engage a person using toys and puzzles they were not interested in playing with. When we spoke to the management team, they told us they were getting to know people to see which indoor activities they are interested in. Other people were supported by staff to undertake activities they enjoyed, such as using tablet PCs, watching the news and discussing future plans for trips. Whilst the décor in the communal areas of the service needed updating, people’s rooms were personalised with items and furniture important to the individual.

The provider had processes in place for supporting people’s independence and encouraging choice and control but staff did not always demonstrate a full understanding. People’s care records provided information on how to maintain and encourage independence and choice in relation to short-term and long-term plans.

People told us they generally felt listened to. Relatives told us they wished they could be more involved. We saw the management team had already sent a letter to relatives introducing themselves and inviting feedback. People had access to a GP on a weekly basis should they require this. Surveys and questionnaires were provided to people in a format they preferred. For example, we saw pictorial questionnaires being used to communicate.

Staff told us they knew how to anticipate triggers and other signs that people may require responding to. Where staff were unsure around one person’s oxygen saturations, the shift leaders and management team were aware of when to escalate and how to do so. The management team told us they had plans in place to ensure they involve relatives further in people’s care in order to ensure needs and wishes are both consistently met.

Whilst not all staff were always confident in using people’s preferred communication methods, we observed staff anticipating and supporting people in a kind and attentive way. We saw a board had been prepared in the communal area for photos of activities and meals to be displayed to aid people’s communication. Staff communicated with people at eye level and held their hands to provide comfort.

Staff told us they felt supported by the new management team. Staff told us they felt able to speak to the management team if they needed further support or in order to discuss workload and safety. Staff told us that the management team asked them how they were doing and reiterating areas of improvement.

Staff had raised concerns or requests for adaptations within supervision. We saw where one staff member had made requests, these had been accommodated. However, concerns about staff making equitable effort in their roles, having annual leave approved and a broken chair in the dining rooms were not addressed in the actions meaning that some staff may not feel listened to. We saw a meeting to address a staff member’s performance which had placed all actions on the staff member without any actions involving exploring or providing additional support which might be needed. At the time of the assessment, most staff were overdue an individual supervision meeting with 30% of staff having up to date supervision. 6 staff members had not had supervision in over four months. There had not been any staff surveys completed. However, we saw group supervisions had taken place to offer support to staff and discuss general performance. The provider shared a wellbeing and inclusion document which stated that in 2024 the organisation would be reviewing their Employee Assistance Programme which was felt to be too limiting currently. It stated that the Training and Consultancy Team, have partnered with the People Team, and have produced a report on workplace adjustments, including a set of recommendations which should result in consistently better experiences for disabled applicants and employees. We saw that staff group meetings were happening but the notes were a one-way dialogue from the senior team to the staff. Staff voice was not recorded and there was no evidence of staff being enabled to contribute or discuss topics. The approach within staff meetings was an itemised list of improvements to be made. There was no recognition or praise communicated to staff. The management team told us praised staff whilst also managing their performance but did not record this in documentation.