David House

David House is a residential care home providing accommodation and personal care to eight people most of whom have mental health needs. Care and support is provided in one adapted building. There were eight people living in the service at the time of our inspection.

People’s experience of using this service and what we found

The service was short of staff. This was the result of staff leaving the service in November 2021 after it became a legal requirement for all care staff to be vaccinated against COVID-19 unless exempt. The shortage of management and staff resulted in a number of shortfalls. These included, recruiting staff without the correct references in place and staff not being provided with regular supervision. The provider’s quality audits failed to identify and rectify these shortfalls. The registered manager did not have a deputy, assistant, senior or team leader at the time of the inspection. This placed all the responsibilities for leadership and for driving improvements on them and contributed to shortfalls we found.

People’s medicines were administered safely and reviewed regularly by health professionals. The risk of people experiencing foreseeable harm was reduced because people had risk assessments in place. Staff were trained to protect people from abuse and the cleanliness of the environment protected people from infection.

People’s needs were assessed, and they participated in their assessments. Staff received an induction and on-going training to meet people’s needs effectively. People ate well and were supported to access healthcare services in a timely manner.

People told us staff were caring and supported them to maintain important relationships. Staff promoted people’s dignity and independence. People participated in the decisions made about their care and support.

The care and support people received was personalised. People engaged in activities and there were plans in place to increase the range of activities people were supported with. People’s communication needs were assessed and met, and people understood how to make a complaint if they were dissatisfied.

People and staff expressed confidence in the registered manager. There was an open culture at the service and the views of all were gathered. The registered manager and staff worked in partnership with other organisations to meet people’s needs.

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.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 3 February 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, environmental safety and food quality. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We found no evidence during this inspection that people were at risk of harm from these concerns. However we have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for David House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified breaches in relation to safe care and treatment, premises, staffing and good governance at this inspection. Please see the action we have told the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

David House is a residential care home registered to provide personal care for to up to eight people. At the time of our inspection the service was supporting three older adults with a learning disability in one adapted building. A fourth person was in hospital.

People’s experience of using this service and what we found

People’s care and support was not always provided safely. This was because staff did not always wear face masks in line with current guidance to prevent the spread of the Covid 19 virus. Risk assessments were not carried out for people or staff to mitigate the risks arising from not wearing face masks.

There were enough staff available at all times to ensure people received their care and support safely as planned. The provider followed appropriate recruitment practices to confirm the safety and suitability of new and potential staff.

Staff stored and administered people’s medicines safely and recorded medicines administration accurately. The new manager introduced new protocols for ‘when required’ medicines which improved people’s safety.

The service did not have a registered manager in post. However, the manager, who had been in post for three weeks at the time of our inspection, had begun the process of becoming a registered manager.

The manager took action when things had gone wrong. This included investigating incidents, liaison with health and social care professionals and improving systems and processes at the service.

The manager was developing quality assurance process and had made improvements to medicines and care records. Staff understood their roles and welcomed the recent improvements at the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: People were able to have control of their lives and chose the activities they participated in.

Right care: People’s care and their care plans were personalised and unique to them as individuals.

Right culture: The manager was new to the service. In the three weeks since taking up they role they had taken action to improve safety, personalisation and quality assurance processes.

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

Rating at last inspection

The last rating for this service was Good (published 22 July 2019).

Why we inspected

We received concerns in relation to the management of risks and people’s behavioural support needs . As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe section of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider has taken action to ensure that staff wear masks when supporting people in line with published guidance.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for David House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to infection prevention and control at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

David House is a residential care home providing personal care to up to eight people aged 65 and over at the time of the inspection. It provides support to older and younger people with a learning disability and autistic spectrum disorder. At the time of our inspection three people were living there. The home is a converted house with a large garden. Bedrooms were on two floors and there were communal lounge and dining areas.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

Everyone we spoke with was positive about David House. We observed that there was a very homely atmosphere and that people and staff had good, caring relationships.

People took part in activities they enjoyed and were able to access the community. Visitors were welcomed. The home had good relationships with health and social care professionals. People had a healthy, varied diet and ate food they enjoyed.

People told us they felt safe and they were protected by staff who understood their responsibilities and how to keep people safe. People were protected from risks by detailed, regularly updated risk assessments.

People had excellent care plans which detailed their strengths and promoted their independence. Their communication needs were assessed and recorded in detail and staff were observed appropriately interacting with people.

There were enough staff to meet people’s needs. Staff were well trained and understood the needs of the people they supported. The home was clean and tidy and good infection control practices were being followed.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection

The last rating for this service was Requires Improvement (published 14 June 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The last comprehensive inspection was on 4 April 2017 when breaches of legal requirements were found in regards to safe care and treatment, staffing and good governance. After the inspection the provider wrote to us to say what they would do to meet the legal requirements. We undertook a focused inspection on 1 August 2017 and found the provider had met the breaches in regulations in regards to safe care and staffing. However, they remained in breach of the regulations under well led. After the inspection the provider wrote to us to say what they were going to do to meet the legal requirements, they told us these would be met by 21 August 2017.

During this inspection we found breaches in safe care and treatment, person centred care, staffing and a continued breach in good governance.You can see the action we asked the provider to take on the back of our full-length report.

David House 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.

David House provides accommodation and support for up to eight adults with learning disabilities, some of whom also have mental health needs and/or are living with dementia. At the time of our inspection four people were using the service.

We met with the manager at this inspection who had made an application to become a registered manager with the CQC. 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 not always protected from the risk of harm due to environmental concerns. One communal window was not restricted meaning people could fall from height. We found a fire door was not linked to an alarm system to alert staff if people left the service. A light was not working in one corridor meaning people could not see where they were walking. Some important checks to ensure people’s safety had not been completed, this included checks for hot water, fire safety and checks to reduce the risk of Legionnaires’ disease.

Not all risk had been identified for people and some risk assessments had not been reviewed. This meant staff did not always have the guidance they needed to support people and manage their risk according to their individual needs.

There were enough staff to keep people safe during our inspection. However, we found past examples where there had been insufficient cover to keep people safe and staff had worked excessive hours putting people at risk of unsafe care.

Staff had received supervision but the providers mandatory training requirements had not been completed so there was a risk staff may not have the knowledge and skills to meet people’s needs. Some recruitment procedures were poor regarding criminal checks so the provider could not be sure staff met the criteria to keep people safe.

The service was poor at identifying and managing risk relating to infection control because monitoring systems were insufficient and out of date.

Medicine audits were carried out by the manager but not everyone had a medicine profile in place with a photograph so staff could be sure they were giving medicine to the right person. Records were not always clear if medicine should be given 'as required' or as a prescribed medicine.

People had limited opportunities to access the community and in-house activities were limited. The service did not always support people to take part in social activities relevant to their individual interests and hobbies. People were not always involved in the development of their care plan and how they wanted to be supported.

When people’s health needs changed these were not always recorded in their records .When healthcare professionals gave advice this was not always recorded. This meant there was a risk that people’s healthcare needs would not be identified or acted on.

The provider had failed to ensure care records and risk assessments were up to date and accurate. Systems were not in place to identify health and safety issues that could put people who used the service and staff at risk. There were no robust systems to check the quality of the service

Some care records focused on people and gave a good picture of the individual including their physical, mental, emotional and social needs. However, other care records needed updating and some were incomplete.

Staff knew how to keep people safe at the service and felt confident raising concerns when they needed to. Systems and processes were in place to report and review accidents and incidents.

We observed kind and considerate interactions between staff and people using the service. Staff were friendly and polite when speaking with people. They were aware of people’s communication methods and offered them choices throughout the day. Staff respected people’s privacy and maintained their dignity.

People were supported to eat and drink enough. Staff knew people’s preferences and individual dietary needs were followed to keep people safe.

Staff supported people in line with the Mental Capacity Act 2005 and in line with the authorisations approved through the deprivation of liberty safeguards.

We undertook this focused inspection on 1 August 2017 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘David House’ on our website at www.cqc.org.uk.

David House provides accommodation and personal care to up to nine adults with a learning disability. At the time of our inspection three people were using the service.

Since our comprehensive inspection a new manager had been appointed. They were registered with us on 8 June 2017. 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 registered manager had introduced new processes to review the quality of some areas of service delivery including ensuring a safe and suitable environment was provided. The registered manager had plans to implement systems to audit medicines management and ensure oversight of service delivery through the completion of provider quality audits. However, these were not in place at the time of our inspection. The provider remained in breach of regulation relating to good governance. You can see what action we have asked the provider to take at the back of this report.

Staffing levels had been reviewed and there were now sufficient numbers of staff to meet people’s needs. Staff had received refresher training and had the knowledge and skills to meet people’s needs.

Work had been completed to ensure a safe and secure environment, including installing window restrictors and alarms on external doors. Medicines management processes had been reviewed and people received their medicines as prescribed.

The provider was now meeting the breach of regulation we identified at our previous inspection in regards to safe care and treatment, and staffing.

David House provides accommodation and support for up to eight adults with learning disabilities, some of whom also have mental health needs and/or are living with dementia. At the time of our inspection five people were using the service.

A registered manager was 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.

We found there were insufficient staff on duty to meet people’s needs and keep them safe in the event of an emergency, especially at night. There was a risk that staff did not have up to date knowledge and skills to meet people’s needs as they were not up to date with their training requirements and many staff had not completed the required refresher training courses.

People were not always protected from the risk of harm due to environmental concerns. Windows were not restricted meaning there was a risk people could fall from height, and external doors to the garden were not secure or linked to an alarm system to alert staff if people left the service.

Safe medicines management was not consistently followed and we identified errors in the recording of medicines administered and stocks of medicines at the service.

With the recent change in provider of the service, this had impacted on the leadership and management of the service. We found there was a lack of communication between the provider and registered manager regarding decisions relating to service delivery. There were processes in place to review the quality of service provision, however, these were not always comprehensive and sufficient action was not always taken to mitigate risks to people’s safety.

The provider was in breach of the legal requirements relating to safe care and treatment, good governance and staffing. You can see what action we have asked the provider to take at the back of this report.

Staff had assessed individual risks to people’s harm and plans were in place to manage and mitigate those risks. Staff were aware of their responsibility to safeguard people from harm and escalated any concerns to the registered manager and the local authority safeguarding team when necessary.

Staff supported people in line with the Mental Capacity Act 2005 and in line with the authorisations approved through the deprivation of liberty safeguards. Staff assisted people with their nutritional and health needs, liaising with other healthcare professionals as and when required.

There were kind and considerate interactions between staff and people using the service. Staff were friendly and polite when speaking with people. They were aware of people’s communication methods and offered them choices throughout the day. Staff respected people’s privacy and maintained their dignity.

Care records provided clear and detailed information about people’s needs, outlining the level of support they required with different tasks and their preferred daily routines. There were some but not many scheduled activities at the service and limited opportunities for people to access the community. We recommend that the provider reviews national guidance to support social inclusion for people, in the community.

The registered manager adhered to the requirements of their registration with the Care Quality Commission and submitted statutory notifications about key events that occurred at the home.