Darwin Place

Darwin Place is a residential care home which accommodates a maximum of seven people who have a learning disability or autistic spectrum disorders. Accommodation is set up across four separate units, each of which has separate adapted facilities. At the time of our inspection five people were using the service.

People’s experience of using this service:

•People and their relatives were positive about the care and support they received. One person said, “The staff are really great. I am very happy here.” A relative said, “All the staff are brilliant. I couldn’t be happier and really can’t think of anything they could do better.”

•Risks to people were monitored and procedures were in place to help keep people safe.

•There were safe systems for the management and administration of people’s prescribed medicines.

•People were supported by adequate numbers of staff who were safe and competent to work with them.

•People were protected from the risks associated with the control and spread of infection.

•Staff understood the importance of ensuring people’s rights were understood and protected.

•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.

•People’s health care and nutritional needs were monitored and understood by staff.

•People told us staff understood their needs and were kind, caring and compassionate.

•People had opportunities for social stimulation and were able to maintain links with the local community.

•The registered manager and provider followed effective procedures to monitor and improve the quality of the service provided.

Rating at last inspection: At our last inspection in February 2018 (report published 3 April 2018) the service was rated requires improvement.

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

Follow up: We will continue to monitor intelligence we receive about the service until we return to

visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

At our last inspection in August 2017 we found the provider was in breach of five regulations: Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider failed to assess and monitor people’s health care needs and this place people at risk of deterioration in their well-being. At this inspection we found action had been taken to reduce these risks. The provider also failed to ensure people received safe care and treatment. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were found at this inspection and people were safe. The provider also failed to ensure that people were protected from abuse and improper treatment. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were noted at this inspection. We also found at the last inspection that the provider’s systems failed to identify, monitor and act upon poor care and treatment and they failed to ensure people were supported by staff who had the knowledge, skills and experience to meet their needs. Improvements were noted at this inspection and people were supported by staff who were trained and knew people well.

Darwin Place is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Darwin Place accommodates a maximum of seven people who have a learning disability or autistic spectrum disorders. Accommodation is set up across four separate units, each of which has separate adapted facilities.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Registering the Right Support CQC policy

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

At the last inspection in August 2017, the service was rated Inadequate and was placed into special measures. Following the inspection we took urgent enforcement action to restrict any admissions to the home.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this inspection we found the service had improved to Requires Improvement overall with a rating of Requires Improvement in the Well-Led domain. There were no breaches of our regulations. However the provider needs to demonstrate the improvements made can be maintained consistently over time and when more people move into the home.

Since the last inspection there had been a change in manager who was yet to register with us. 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 now supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. There were now systems in place to identify and manage risks and to protect people from harm or abuse. People received their medicines when they needed them and medicines were stored and managed in a safe way.

People were now supported by a core team of staff who knew them well. Staff had the skills and training to meet the needs of the people who lived at the home. Communication systems had improved which meant the effectiveness of people’s plan of care could be reviewed. 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. People were supported to eat well in accordance with their needs and preferences. People saw health care professionals to ensure their needs were met.

People now lived in an environment which met their needs and promoted their well-being. Staff were kind and considerate and people’s right to privacy was respected. People were supported to exercise choice and control over their lives.

People now received a service which was responsive to their needs and preferences. Staff knew what was important to the people they supported and people were involved in planning and reviewing the care they received. There was a varied programme of activities which were based on people’s preferences.

There were improvements in the provider’s systems for monitoring the quality of service people received. However more time is needed to ensure systems can be maintained consistently over time and when more people move into the home. Staff morale had improved and staff felt supported in their role.

Further information is in the detailed findings below

Darwin Place Residential Home offers accommodation for up to seven people with learning disabilities or autistic spectrum disorders. There were seven people living at the home at the time of our inspection. The home consists of a main bungalow where four people live, and three individual flats.

The service was previously inspected on 23 September 2016 and was rated good in all areas.

At this inspection, we found breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to person centred care, safe care and treatment, safeguarding people from abuse and improper treatment, staffing and good governance.

There was not a registered manager in post at the time of our visit. 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. There was a manager in post who was available on all days of the inspection. This person had been employed by the service since 5 June 2017. They had not yet applied to be registered with the Care Quality Commission (CQC).

People were not fully protected from harm and abuse. Incidents had occurred when people and staff had been hurt. The staff had not followed safeguarding protocols and incidents had not been reported to out-side agencies. Referrals had not been made to the local safeguarding authority when safeguarding incidents had happened. People had not had risks to their health and safety assessed sufficiently to reduce the likelihood of harm or abuse occurring.

The management of medicines was unsafe. People did not receive their prescribed medicines at the right times. Medication administration records (MARs) for some people had been signed to indicate they had received prescribed medication which had not been given. Handwritten MARs had not been signed by two staff to ensure the accuracy of the information recorded and some MARs did not provide instructions about the use of medicines. This put people's health safety and wellbeing at risk.

People were not always supported by staff who had the required knowledge and experience to enable them to lead a happy life. People were not always supported in a respectful manner by staff. People’s confidentiality was not always respected.

Care plans did not contain all the information needed to make sure people received the care and support that they needed. People’s health needs were not always monitored when required to prevent deterioration in chronic conditions.

People were not provided with information on how to complain.

There was no registered manager. There was a lack of continuity in the management of the service, which had impacted on people, staff and the service provided. The provider had not taken appropriate steps to ensure they had oversight and scrutiny to monitor and support the service, and take prompt action where poor care was identified. The provider had not informed CQC of important events that occurred at the service, in line with current legislation.

The overall rating for this service is Inadequate which means it will be placed into special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Darwin Place Residential Home offers accommodation for up to seven people with learning disabilities or autistic spectrum disorders. There were seven people living at the home at the time of our inspection. The home consists of a main bungalow where four people lived, and three individual flats.

The service was previously inspected on 8 August 2013 and met all requirements of the law.

There was not a registered manager in post at the time of our visit. 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. There was an acting manager in post who was unavailable on our first day. This person had been employed by the service since 6 June 2016. They were currently processing their application to be registered with the Care Quality Commission (CQC).

People were protected from the risk of harm and abuse by staff who knew how to recognise and respond appropriately to any concerns that they had. Staff knew how to support people safely. Risks associated with people's care and support had been appropriately assessed and included ways to enable people to take risks, which respected their wish to try new things. Staff were knowledgeable about the Mental Capacity Act and enabled people to make decisions for themselves as far as possible.

There were sufficient staff employed to meet the needs of each individual living at the service. Staff did not start work until checks had been made to make sure they were suitable to support people and keep them safe. People were supported by a staff team who had the knowledge and motivation to be able to enhance their lives. People's independence was actively promoted. People and their families were included in any decision making and their views respected about what they wanted to do each day. Relatives were fully involved in the lives of their family members and good levels of communication were maintained. People were supported to access external healthcare support when required. The staff team had developed excellent collaborative relationships with the external professionals. They all worked together to ensure people's health needs were proactively met.

People had their nutritional needs assessed and people were supported to be involved in meal preparation. Mealtimes were friendly and sociable occasions with much interaction between people and staff. People were supported to take their medicines as prescribed by staff who knew what they were for. Medicines were ordered, stored and dispensed according to national guidelines.

Staff supported people in a caring, respectful and dignified way. People and their families were fully involved in the development of individual care and support plans. Activities were both joint and individual to the person and much support was provided to enable people to take part. People were actively supported to talk about their views on the service provided, and make a complaint if required.

The acting manager was approachable. There was a positive and inclusive culture in the service where the staff and manager worked together as a team to ensure people's needs and wishes were met. The provider had checks in place to monitor the quality of the service and encouraged staff to drive improvements in the service.

Staff spoke about the significant improvements made since our last inspection. They told us people's quality of life had dramatically improved and that people were provided with greater opportunities to lead active lives in accordance with their needs and preferences.

Care records we sampled had been reviewed and updated. We saw people were involved in their care and support as much as they were able. Risk assessments had also been reviewed and updated. These ensured risks were identified and assessed to ensure people's safety and welfare.

Staff demonstrated a good understanding of abuse. They told us they had not observed any poor practice since our last inspection and knew how to report any concerns.

Staff told us they felt well supported in their work and had attended training to keep people safe and meet their needs. We saw staff had received regular supervision and an appraisal.

We found there were systems in place to monitor the quality of the service.

Although we spoke with two people who received a service, they were not able to express their views about the service in any detail. However, everyone we saw appeared to be happy and relaxed.

We found that people were consulted about the support they received and had the opportunity to contribute as much as they were able.

Care plans were written in an easy to read format to help people understand them. However, care plans had not been properly reviewed or updated to reflect people's changing needs. Appropriate risk assessments had been carried out for each person but these had not been recently reviewed. Staff told us that they had not received any training specific to the needs of the people they cared for.

We found that staff had not received appropriate supervision or appraisal. One new member of staff had not received any supervision or induction training for the first two months of their employment. Staff told us that they had not felt supported or listened to by the previous manager.

The company that owned the home had begun to address a number of issues with the home after a member of staff used the home's internal whistle blowing procedure to alert them.