About the service:

Delrose is a care home that provided personal care to five people with a learning disability or autism at the time of this inspection.

People’s experience of using this service:

Since our last inspection the registered manager and other managers had left the service. The provider had made arrangements to cover their absence. However, they had not made all the improvements identified at our last inspection. There had been no registered manager in post since August 2018.

The provider had made improvements to people’s individual risk assessments and had improved the process for keeping people safe from unwanted intruders in the home. However, there was still a risk that people might receive unsafe or inappropriate care and support because the provider’s processes to learn from accidents and incidents were not followed. Processes were in place to protect people from risks associated with medicines, the spread of infection, and risks arising from insufficient numbers of suitable staff.

The provider had made improvements to how they supported staff to deliver effective care and support in line with people’s needs, and staff felt supported. However, records in place did not show that all staff had received all the training they needed, particularly around managing people’s behaviours. There had been no formal process of supervision and appraisal, although the interim manager had taken steps to restart this.

The atmosphere in the home had improved, and staff were more motivated and empowered. There were systems in place to monitor and assess the quality of service, but these had not been effective in delivering all the improvements needed to comply with regulations in a timely fashion. The provider had not met all their regulatory requirements.

People were well treated and supported. Staff helped them to be as involved as possible in decisions about their care. Staff treated people with respect.

People received care and support which met their individual needs and reflected their preferences. The provider took complaints and concerns seriously as opportunities for improvement.

People’s assessments and care plans were detailed and individual to the person. People’s care and support included effective plans to support them to have a healthy diet, and to access other healthcare services. Where people lacked capacity to make decisions the provider acted in line with legal requirements to support people to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible, and the policies and systems in the service supported this practice.

Rating at last inspection:

At our last inspection (report published 29 June 2018) we rated the service requires improvement. This is the second consecutive rating of requires improvement.

Why we inspected:

We carried out an announced comprehensive inspection of this service on 12 and 16 April 2018. We found breaches of legal requirements. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that 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 Delrose on our website at www.cqc.org.uk.

The comprehensive inspection in April 2018 identified concerns in all five key areas. We therefore covered all five key areas in this inspection.

Enforcement:

We found three continuing breaches and one new breach of regulations. You can see the action the provider needs to take at the end of our full report.

Follow up:

Until the provider can show they are compliant with the fundamental standards in the regulations, we will continue to monitor the provider’s progress in line with our procedures for s

The inspection took place on 12 and 16 April 2018. We gave the provider notice of our intention to visit so that they could prepare people with complex needs whose routines might be disrupted by our inspection process.

At our last inspection in April 2017 we rated Delrose as good. However we had received information of concern which prompted us to return ahead of the next scheduled inspection. This was a comprehensive inspection which looked at all areas of the service. We identified breaches of four regulations and found areas for improvement in all key areas. You can see what action we have told the provider to take at the end of the full version of this report.

Delrose provides residential care and support to a maximum of nine people who may be living with a learning disability, autism, or have mental health needs. The service occupies a large converted residential home near to local shops and other services.

Delrose 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.

Since the provider registered to carry on a regulated activity at Delrose, we have published guidance called “Registering the Right Support” for services for people with a learning disability or autism. The values which underpin “Registering the Right Support” include choice, promotion of independence and inclusion. People with a learning disability or autism using the service can live as ordinary a life as any citizen.

Although Delrose is close to local community facilities, its location on a busy main road introduced risks to the safety of people with very complex needs, which the provider found difficult to manage in a way that allowed people to access the community as freely as any citizen. There were people living at Delrose whose family did not live nearby which meant the service was not meeting an entirely local need for this type of service, and the provider had experienced recent difficulties in recruiting suitable staff from the local community.

There was a registered manager in post who was also the provider’s area manager. A registered manager is a person who has registered with us 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 provider’s system of risk identification and risk assessment was not always interlocked with the support planning process which meant people were not fully protected against risks to their safety and welfare. The provider had not made sure people were supported by staff with sufficient knowledge and experience to support them safely. The provider’s process to review and learn from accidents and incidents was not always followed.

The provider had not managed the induction of new staff effectively which meant people were supported by staff whose competence to support them had not been signed off. Staff were not supported to deliver high standards of care and support because the provider did not make sure there were timely supervisions in line with the provider’s own policy.

People did not always receive care and support that met their needs and reflected their preferences. The provider’s governance processes were not operated effectively to identify where the service failed to meet the fundamental standards that people should be able to expect.

The provider had processes in place to manage and administer people’s medicines safely. The home was well maintained and kept clean. There were arrangements to protect people from the risk of the spread of infection.

Staff supported people to eat and drink enough and advised them on keeping to a healthy diet while respecting their right to make choices about their diet. Staff were m

We carried out this unannounced inspection on the 25 and 26 April 2017. Delrose provides accommodation and support with personal care to a maximum of nine adults with learning disabilities or who have autism spectrum disorder. At the time of our inspection there were seven people living at the home.

The home had a registered manager. 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.

Relevant recruitment checks were conducted before staff started working at Delrose to make sure they were of good character and had the necessary skills. However, for some staff unexplained gaps in employment history had not been challenged by the provider.

People and their families told us they felt safe and secure when receiving care. Risk assessments were in place which minimised risks to people living at the home and fire safety checks were carried out.

Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

Staff were trained and assessed as competent to support people with medicines. Medication administration records (MAR) confirmed people had received their medicines as prescribed.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were taken in the best interests of people.

New staff completed an induction designed to ensure staff understood their new role before being permitted to work unsupervised. Staff told us they felt supported and received regular supervision and support to discuss areas of development.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities. Staff knew what was important to people and encouraged them to be as independent as possible.

People received varied meals, including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes.

Staff were responsive to people’s needs which were detailed in people’s care plans. Care plans were regularly reviewed to ensure people received personalised care. A complaints procedure was in place.

Staff felt supported by the manager and staff meetings took place.