Dorandene - Care Home Learning Disabilities

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At the last inspection, we found that people did not have access to a varied diet, snacks and sufficient food. We found that this was no longer the case and people were being offered cooked meals throughout the day and had access to snacks. There were systems in place to assess people prior to moving into the service. The process included trials, ensuring healthcare needs could be met and ensuring that the person fits into the local community of the service. Since the last inspection, there had been no further admissions to the service. The management team told us people and their relatives would be involved in the process as well as healthcare professionals. Relatives told us frequent changes in management since the last inspection meant a lack of consistency in their involvement and that they would prefer to have been involved more closely by previous management teams. We received mixed feedback from visiting professionals. Some commented on the improvements that had been made by the management team which meant they could be assured their recommendations would be implemented and others commented that whilst there were improvements, these were sometimes not as immediate as they would have liked. People’s healthcare outcomes had improved as a result of the service improving their work with visiting professionals. We saw documentation which showed that feedback from visiting professionals was taken on-board and included in people’s care records. The provider had policies and procedures in place in relation to mental capacity, consent and restrictions on people’s liberty. People’s care records included mental capacity assessments and best interest decisions where people lacked capacity. People’s representatives and the local authority were involved in the process. However, people were not consistently given a choice prior to staff commencing tasks. For example, we observed a member of staff wiping a person’s mouth following a meal without asking them first.

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.

There were systems in place to assess people’s needs prior to moving into the service to ensure needs and preferences could be met. Whilst the previous inspection identified that one person’s pre-admission assessment was missing, no new service users had moved into the service since the last inspection. The pre-admission assessment included information on people’s healthcare needs and to ensure people fit into the social community of the home. Relatives told us that regular changes in management since the last inspection have meant a lack of consistency in their involvement and that they would prefer to have been involved more closely by previous management teams.

Staff told us that the service had systems in place to assess people prior to moving into the service. This included completing a trial to see how people react and assessing their health and care needs. Staff told us they knew where to find information on people’s needs and preferences and that they had time to read people’s care records. Staff told us they felt able to communicate with management about changes to people’s needs in order for care records to reflect these.

Care records included assessments of people’s needs and preferences, goals and objectives, and information about the most important relatives and friends in people’s lives. Assessments also included information on people’s preferred communication methods and communication aids. We did not see these being used effectively during the site visit. Staff told us they understood people’s needs and when they would like to be supported, but assessments included information on easy-read documentation and pictorial aids. We did not see these being used but we saw staff communicating by holding people’s hands and being led by them. This helped manage a person’s anxieties. The management of the service was already aware of this and showed us the pictorial aids they were planning to use and had created spaces to display pictorial food choices on the dining room wall.

People were generally involved in making decisions about their care, however we observed examples where staff did not follow statutory guidance such as Right Support, Right Care, Right Culture (RSRCRC). RSRCRC states that people should be encouraged to make decisions about their care and this was not always the case, such as when people were assisted with personal care. The management team discussed this with staff following our first on-site visit. When we visited the following day, staff had taken this on-board, and we saw staff asking people for consent prior to commencing a task. We saw in care records that people’s relatives were generally involved in the decision-making to meet care needs.

Staff were not always aware of national guidance, such as RSRCRC. Staff were unable to describe what the guidance entailed and how to ensure people were supported to make independent choices in line with it. However, staff told us they understood that people’s decisions should be respected and that the individual has the ultimate choice. The management team understood the guidance and had started to coach staff on this.

Care records included information on people’s treatment and care. This included goals, medical conditions and guidance from relevant healthcare professionals. Staff had undertaken training and group supervisions to support them to deliver care.

Whilst there had been issues previously in how the service worked internally and with external partners, we received feedback that this had improved. We saw the new manager had sent a letter to all people and relatives informing them that they were managing the service and would welcome feedback.

Staff told us they worked well together to achieve positive outcomes for people. Staff acknowledged that there was further work to do but that there had been positive progress. The management team told us they had spent time coaching staff and completing group supervisions to build trust and provide feedback to staff.

Feedback from visiting professionals was mixed. Some commented on the improvements that had been made by the management team which meant they could be assured their instructions would be followed and others commented that whilst there were improvements, these were sometimes not as immediate as they would have liked. We discussed this with the provider and sought assurances. The provider told us they were recruiting a dedicated team to over see the services and were overseeing the service directly themselves in the meantime to ensure improvements are embedded.

People’s care and governance records showed they were generally referred to other services when they required this. The management team had prioritised this by following up healthcare referrals where this had not yet been done.

People had access to their GP and were able to receive referrals to specialised healthcare professionals. Whilst staff referred people to specialist services, this was not always done in a proactive way. The management team acknowledged this and told us they were working with the GP to improve this. For example, where people were at risk of choking, we saw involvement from the speech and language therapist but where people were at risk of falls due to mobility issues, this had not always been referred to appropriate professionals to seek guidance. We were told that this had been done during our second site visit. People had access to dentists and we saw that they had been reviewed recently. Staff had received coaching and training on improving meals since the last inspection, which included preparing nutritionally balanced diets by taking into account people’s individual preferences.

Staff told us they knew when to report concerns or changes in healthcare needs to the management team. Staff told us they felt supported by the management team in escalating changes to the appropriate healthcare professional. Staff told us they were contacted by the GP surgery on a weekly basis to discuss whether people need to be seen that week.

People’s care records confirmed people had access to a GP and their medicines were reviewed regularly. People’s records indicated that people had been seen by specialist healthcare services such as the speech and language therapist and held regular handovers to discuss changes. People’s care records included information which could be shared with healthcare professionals in an emergency. People had care plans in place for specific conditions, such as where people were at risk of choking.

At the last inspection, there was a lack of varied meals and snacks. This had improved significantly as staff were preparing more meals and offering people snacks throughout the day. People told us they enjoyed the food. Relatives told us that there had been an improvement in relation to the variety of meals on offer and people’s quality of life had improved as a result of this. There was still further work for the management team in relation to ensuring consistently positive outcomes for people as we have highlighted under the quality statement ‘Supporting people to live healthier lives”.

Staff told us they reviewed people’s goals and outcomes. For example, where a person wished to become more independent by going to the shops to buy toiletries, staff told us how they supported them to do this.

Care records included individual goals and objectives for people. However, there was no evidence that the documentation had been reviewed since it was created. We saw several people’s goals were being met as people were attending external activities and visiting local shops and pubs during the site visits, but this was not always recorded in people’s care plans. There was further work to do in order to consistently ensure that people’s goals were being reviewed.

People were not consistently given a choice prior to staff commencing tasks. For example, we observed a member of staff wiping a person’s mouth following a meal without asking them first. The person was able to complete the task independently as we observed once the management team intervened. The management team was aware of this and was putting measures in place such as additional training and coaching. We saw this had improved by our second site visit as people were being asked for permission prior to a task being commenced. There was further work required to embed the management team’s values in the service.

Staff told us they had received training in relation to the Mental Capacity Act and were able to tell us what they should do, such as respecting people’s choice, asking for consent prior to commencing tasks and respecting people’s right to privacy. However, as highlighted above, we observed an instance when staff did not follow this. The management team was experienced in supporting people with a learning disability and/or autistic people and was aware of this. The management team provided us with assurances that they were coaching staff and providing additional training and we saw that this was happening.

The provider had policies and procedures in place in relation to mental capacity, consent and restrictions on people’s liberty. People’s care records included mental capacity assessments and best interest decisions when people lacked capacity. Care records showed that people’s representatives and the local authority were involved in the process. At the last inspection, we saw that restrictions on people’s liberty had been agreed by the local authority, such as locked doors to keep people safe. We saw that this had now been completed.