Dorandene - Care Home Learning Disabilities

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People’s care needs and preferences were recorded in care plans and people were able to access healthcare services in response to their needs and wishes. Whilst people were generally put at the centre of their care, staff did not always involve relatives in people’s care. This was an area for improvement. Care records were generally detailed and included social and healthcare needs and preferences. Care plans provided staff with the information required to support people. However, staff did not always demonstrate that they were able to communicate effectively with people. The management team had started to produce pictorial communication aids and we saw staff being coached throughout our site visits in relation to different areas of care. Activities had significantly improved since the last inspection and people were going out to the community regularly. Care delivered was not always in line with RSRCRC as it did not always directly involve people making decisions about their lives.

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’s experience of the care they received has improved significantly since the last inspection as people were regularly going out to attend activities they enjoyed. People told us they were generally happy living at the service and they felt staff listened to them. However, some relatives told us they would like to be more involved in people’s care planning. Whilst people did not complain, we found people were sitting in the communal areas for long periods when they were not outside. People were not always interested in the indoor activities they were being offered by staff, which indicated that these were not always planned in a person-centred way. This was not in line with RSRCRC as people were not always fully involved in making decisions about their lives. We discussed this with the management team who showed us new activity plans they were in the process of implementing and how they had started coaching staff.

Staff told us they understood the importance of providing care which was person-centred. However, the management team had already identified that staff required further coaching in order to better understand how to involve people consistently in the decision-making.

People’s daily progress notes required further work. Whilst some parts were very detailed and included specific tasks undertaken and discussions which staff had with people, other parts were less detailed and did not always record whether consent was sought. People’s emotions were recorded in their daily notes, such as whether people appeared happy and how they felt about appointments they had recently. During our site visit, we saw people being offered a choice in relation to meals, whether they would like to attend an activity and whether they wished to see a visiting healthcare professional.

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 have moved into the service since the last inspection.

Staff were generally responsive and considered people’s protected characteristics, such as their religion. The management team told us they worked together with people, their relatives, staff and visiting professionals to achieve positive outcomes for people. We could see that further time was required to embed the management team’s values in the service.

We were told by some professionals who visited the service that the care provisions in place were not always consistent. Others told us that the care provided had improved since the appointment of the new management team. One visiting healthcare professional on the day of the site visit told us staff had been responsive in the provision of care and that there had been improvements, but that there was further work required for staff to be consistently proactive in supporting people.

Care records were reviewed to include changes in people’s needs. Records were personalised and generally detailed. Some records could have included further information such as following up on goals. The management team told us they were reviewing everybody’s care plans and adding further details once they had spoken to people and their relatives.

People generally had access to information and advice about health, care and support in a format that was accessible for them. We saw information displayed across the service in different formats such as easy-read or pictorial. This included complaints procedures and safeguarding information. However, meal plans were not always available in different formats despite people’s care plans stating that they could benefit from them. The management team was aware of this and had already started a process to ensure communication aids were available. We saw staff offering people choices by visually showing them items and by understanding people’s responses to questions.

Staff told us they were aware of people’s communication needs. Staff told us they understood what it meant when people responded to them and we saw this to be the case. However, there was further room for improvement to ensure staff always had access to communication aids indicated in people’s care plans.

People’s care plans provided guidance on how people communicate and which communication aids to use. We found that staff were not always using these to the full extent. The management team understood this and had started to implement pictorial communication aids. Surveys and other methods of collecting feedback were available in different formats to suit people’s preferences, and we saw them being completed with the support of staff.

People told us they felt involved in the service and listened to, however, relatives told us they did not always feel listened to and involved in the care being provided. The management team put systems in place with a timeline to ensure relatives would be involved and listened to. This included writing to relatives to introduce themselves and organising events for relatives to attend.

Staff told us they generally felt listened to and involved. However, we found instances where feedback from staff was not always acted on. The management team told us they were currently supporting staff amidst changes of staff teams in the service.

Staff supported people to voice their opinions in a format that suited them. We saw visiting relatives had been asked for their feedback and had identified areas of improvement which the management team were addressing. Whilst there was a complaints procedure in place, no complaints had been recorded or analysed to see if there was a pattern and whether any lessons could be learnt.

People and their relatives we spoke with did not express any issues in relation to equity in access.

Staff understood their responsibilities in ensuring they complied with legal equality and human rights requirements. The management team told us they expected staff to be respectful and treat people fairly. As we have commented in the quality statement We saw that the management team took action where this was not the case.

We received mixed feedback from partners in relation to equity in access. Some partners told us that people were always treated in an equitable way, whilst others commented that there was further work to do despite the progress of the new management team. The management team was aware of this and was working with the local community to look at ways of increasing the number of trips they could undertake for those people who had barriers they needed staff support with.

People’s care records included information around people’s sensory and communication needs. The provider had procedures and policies in place for people to have equity in accessing care and treatment. Where reasonable adjustments could be made, this had been done, such as shower rails and information availability in different formats.

People we spoke with did not express any issues in relation to equity in experiences and outcomes.

Staff told us there was an inclusive atmosphere at the service and people’s differences were respected. The management team told us they operated an open-door policy and were visible in the service in order to overcome barriers and be approachable.

People’s care records showed that people’s human rights and protected characteristics were included in their care planning. For example, people’s cultural needs and physical barriers were discussed in their care plans and how staff could support them effectively.

People and their relatives we spoke with did not express any issues in relation to planning for the future. However, one relative told us they wanted to take out a funeral plan but did not know who to approach in relation to this.

Staff we spoke with told us that they knew where to find the information around end of life care in people’s folders. Staff told us that families and their wishes should be considered as part of the end of life plans.

People’s care plans included basic information on their wishes, such as whether people wished to remain in the service or whether they wished to go to a hospice for the last few days of their lives. End of life care plans also included information on resuscitation documentation and the people important to the individual.