About the service: Dillan Care Pathway provides personal care to people across two supported living locations. At the time of the inspection, 17 young adults over the age of 18 with a learning disability, were using the service. Some people who used the service also had a physical disability.

People’s experience of using this service:

People were positive about living at Dillan Care Pathway. Overall, relatives were satisfied with the service, however, we received consistent feedback that the service could offer more with regards to activities and community access.

Not all people were receiving care which was personalised to their needs and preferences. Meaningful activities in one location were lacking and people were not supported to access the community on a regular basis. Care records indicated that people spent large amounts of time watching television and videos, colouring books and walking within the house and garden.

Risks associated with people’s care needs had not always been assessed in a person-centred way. Detailed guidance was not always available for staff to keep people safe.

Systems were in place to ensure people had received their medicines, as prescribed. However, guidance for the use of ‘as needed’ PRN medicines was not in place and detailed records were not kept when PRN medicines were administered.

The registered manager had completed audits on the home to support quality checks. However, for some areas, these had not identified where improvements needed to be made. Policies were out of date and not based on current best practice.

We observed some positive interactions between people and care staff. However, we also observed some negative interactions, which did not promote a respectful environment.

People had good health care support from professionals. Staff worked in partnership with health and care professionals.

People and relatives were positive about the food choices on offer. People’s cultural dietary needs were met.

There was sufficient staff to support people. Staff were safely recruited. However, gaps in staff member’s employment was not always explored and documented.

More information is in the detailed findings below.

We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment, person centred care and the governance of the service. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Good (report published July 2017).

Why we inspected: This inspection was brought forward in response to incidents that had occurred in the service and concerns that had been raised about the safety and management of the service.

Enforcement: We served a warning notice on the registered provider for a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated

Activities) Regulations 2014.

Follow up: We will re-inspect to check compliance with the warning notice. We will also ask the provider to submit an action plan detailing the steps they intend to take to ensure the required improvements are implemented. We will also 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.

Dillan Care Pathway is registered to provide domiciliary care and a supported living service. At the time of the inspection, the service did not have any people receiving domiciliary care services and was providing 24 hour supported living services to 14 people with a learning disability, autistic spectrum disorder or a mental health condition from two addresses. A supported living service is one where people receive care and support to enable people to live independently.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

The service operated effective systems to prevent abuse of people using the service by ensuring staff had a good understanding of their role in identifying and reporting abuse or any concerns of poor care. The service kept accurate records of accidents and incidents and demonstrated learning had taken place to prevent future reoccurrences. Sufficient staff were deployed to meet people’s individual needs. The service maintained safe medicines administration processes and met infection prevention control requirements.

The service followed safe recruitment procedures to ensure staff had been properly vetted before starting work with vulnerable people. People’s health and care needs were met by well trained staff. Staff received regular support and supervision. People’s nutrition and hydration needs were met and they were offered plenty of options in line with their cultural dietary needs.

The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People and their relatives told us staff were friendly, caring and helpful. People received person-centred care from staff that treated them dignity and respect.

Staff supported people to attend a wide range of individual and group activities on the premises and in the wider community, including college. The service was responsive to people’s changing needs and documented changes in people’s care plans. Care plans were personalised and detailed life histories, individual needs and likes and dislikes were recorded.

The service carried out regular monitoring checks and audits to identify any gaps and areas of improvement in quality and safety of the service delivery.

Further information is in the detailed findings below.

This was an announced inspection which took place on 4 May 2016. We gave the provider 24 hours’ notice of our intended inspection to ensure the registered manager was available in the office to meet us. We last inspected the home on 26 April 2014 to review the changes made by the home following our concerns regarding environment within the home under ‘safety and suitability of premises’ essential standards. This was an unannounced inspection. At this inspection, we found all areas that were poorly maintained had been rectified.

Dillan Care Pathway is registered to provide domiciliary care and a supported living service. At the time of the inspection, they did not have any people receiving domiciliary care services. Dillan Care Pathway provided supported living services including personal care and support to people with a learning disability, autistic spectrum disorder or a mental health condition. A supported living service is one where people receive care and support to enable people to live independently.

At the time of our inspection, the service was providing 24 hour supported living services to eight people, majority of people using the service were under the age of 30 and this service was provided from one address. The provider also operated a residential care service from the same address. The same staff team and policies covered both services. As the residential care service was inspected within the same month, we have utilised information from both inspections for each report.

The service was located in two adjoining terraced houses and there was access to a back garden. The exit from the connected house was via a main door at 24 Talbot Crescent. Bedrooms were located on the ground floor and the first floor. Bedrooms had toilet and shower facilities. There was no lift at the premises and hence, people using wheelchair resided on the ground floor.

The service had a registered manager who has been registered with the Care Quality Commission. 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 and their relatives told us they found staff caring, friendly and helpful. People and relatives told us staff listened to them and their individual health and care needs were met. Staff were able to demonstrate their understanding of the needs and preferences of the people they cared, for example we could see staff provided care that maintained people’s privacy and dignity.

The service supported people to attend a wide range of activities in the community, including college.

We checked medicines administration charts and found that clear and accurate records were being kept of medicines administered by staff. Care plans and risk assessments supported the safe handling of people's medicines. Care plans were personalised and detailed life histories, individual needs and likes and dislikes were recorded. Risk assessments were detailed and individualised, and care records were maintained efficiently.

There were safeguarding policies and procedures in place. Staff were able to demonstrate their role in make safeguarding alerts and raising concerns. Staff had a good understanding of the threshold of safeguarding and the role of external agencies.

Staff told us they were supported well; we evidenced records of staff supervision. Staff told us they attended induction training and additional training and training records evidenced this.

Staff files had records of application form, interview assessment notes, criminal record checks and reference checks. Up until September 2015, references were not always from previous employers nor validated by company stamp or headed paper. Since September 2015 the provider had been adopting a more rigoro

At our inspection on 17 September 2013, we identified concerns in relation to the environment within the home. For example,

a table in one of the lounges was not safe and some lighting was poor and badly maintained. We issued the home a compliance action, and in response the provider sent us a plan to rectify our findings.

At this inspection, we returned to review the changes made by the home. We found that broken furniture and loose fittings had been replaced. Where there was ongoing maintenance work in the home, these areas were fenced off. We saw staff ensured people's safety within their environment.

At our inspection on 21 March 2013 we identified concerns related to obtaining valid consent, delivery of care and employment of sufficient numbers of staff and we asked the provider to address this with an action plan. At our follow up visit on 17 September 2013 we found these issues had not been resolved and served warning notices on the registered manager at provider.

At this inspection, we found capacity assesments had been obtained and care plans had been updated to match requirements. Care plans were up to date and accurately described people's communication methods, daily preferences and health needs. A key working system had been implemented. The number of staff on shift each day was increased from six to seven. Established care staff were clear about the difference between people who had supported living needs and the two service users requiring residential care living at the location. The provider had continued to recruit care workers.

Overall, we found the service had taken steps to address people's individual needs.

We spoke with four people who lived at the home including two people on residential care contracts. People told us they were happy and liked living there. We observed that the atmosphere was relaxed and friendly. Staff we spoke with were knowledgeable in respect of how to respond to allegations of abuse and were aware of the types of abuse that could occur and what to do.

The provider had made some improvements since our inspection of 7 March 2013 in relation to staff recruitment and training and records relating to these. They had introduced systems to monitor the quality of service provided although these needed further development.

However, issues related to obtaining valid consent, delivery of care and employment of sufficient numbers of staff had not been resolved. People had complex needs but requirements specified in their support plans were not provided as there were insufficient staff. Records about people’s care were not up to date, following review of changing needs, or complete. The registered manager had arranged for more staff to be recruited, however there was little change in staffing complement and was not linked to people's needs in relation to their supported living care contracts.

We also identified some new concerns, in relation to the environment for example. A table in one of the lounges was not safe and some lighting was poor and badly maintained.

Most of the people who used the service communicated through mainly non-verbal methods. We spoke with three people who lived at the home on supported living contracts, and four people's relatives or social workers. People living at the home told us that they were happy and felt safe. One person said "Yes, happy." Another person's relative told us "there is a real calm about the home." We observed that people were enjoying themselves and the atmosphere was relaxed.

However we found that the provider did not act fully in accordance with their own policy where people lacked capacity to make informed decisions about their care. Of the four care plans we reviewed, we found some aspects of planned care were not recorded as being delivered. The registered manager was unable to demonstrate how people were being provided with the care as required in their contracts with local authorities. Staff received some training but supervision and appraisals were not being held routinely. We found that appropriate checks prior to employment had not always taken place. Monitoring of the quality of the service did not address areas needed to protect people from avoidable risks. The provider had also failed to notify us of incidents of injury and abuse.

Most of the people who use the service communicated through non-verbal methods. In order to gain people’s experience of the service, we observed care practices.

Staff interacted positively with people and provided an inclusive environment. People using the service were well supported to attend regular college and/or day care services and their busy programme of activities. Staffing levels were sufficient to ensure that people were supported to keep to their programme of activities.

Staff approached people with dignity and respect. People appeared to be comfortable in the presence of staff and showed signs of well-being, and seemed genuinely happy to return home from their day activities. When we asked a person if they felt safe at the service, they responded with a yes. We saw that a booklet about safeguarding people from abuse was made available to people in an easy read format in the main reception area of the service.

Staff demonstrated a good understanding of the ethos of the service, and the need to respect people’s rights. They were very attentive to the needs of the people using the service. When we asked a person using the service if staff treated them well, they answered yes. Staff showed a good awareness of the needs of people using the service. We observed staff interpreting people’s non-verbal signs and responding to these. Staff were respecting people’s rights to make choices, for example to choose the activities they wished to take part in, and what they would like to eat and drink.

We asked a person using the service if they felt staff did a good job and if they were happy where they lived to which they answered yes.