About the service:

Duke Street Bungalows 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 care provided, and both were looked at during this inspection.

The service supported people with learning disabilities and/or autism. The service was registered to care for 20 people; 15 people were using the service.

Duke Street Bungalows accommodates 15 people across three separate bungalows, each of which has separate adapted facilities. Each bungalow had a kitchen with an adjoining dining room, communal area, laundry and shared bathrooms with appropriate facilities. Each bungalow also had an office where people’s care plans were kept. People had individual bedrooms. Five people lived in one bungalow, four people lived in a second bungalow and six people lived in a third bungalow.

People’s experience of using this service:

• The service has been developed and designed in line with the principles and values of 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 received planned and co-ordinated person-centred support that is appropriate and inclusive for them.

• Some staff did not always promote people’s dignity and privacy. Some staff did not always provide person-centred support by listening to people and engaging them at every opportunity. Most staff were very kind and caring and people using the service responded well to them.

• People were not always supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

• Staff were trained and supported to be skilled and efficient in their roles. They were very happy about the level of training and support they received and most staff showed competence when supporting people.

• The provider sought the views of people’s relatives and took opportunities to improve the service. Staff were supervised, supported and clear about what was expected of them. Audits and checks were carried out, so any problem could be identified and rectified.

• The provider had processes in place for recruitment, staffing levels, medicines management, infection control and upkeep of the premises which protected people from unsafe situations and harm.

• Staff understood their responsibilities to protect people from abuse and discrimination. They knew to report any concerns and ensure action was taken. The registered manager worked with the local authority safeguarding adults team to protect people.

• The premises provided people with a variety of spaces for their use with relevant facilities to meet their needs. Bedrooms were very individual and age and gender appropriate.

• Support plans were detailed and reviewed with the person when possible, staff who supported the person and family members. Staff looked to identify best practise and used this to people’s benefit. Staff worked with and took advice from healthcare professionals. People’s health care needs were met.

• People had a variety of internal activities (such as music and games) and external activities which they enjoyed on a regular basis.

We have made a recommendation about involving people in decisions about their care.

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

Rating at last inspection:

At the last inspection the service was rated Good (13 October 2016). At this inspection, the overall rating has remained the same.

Why we inspected:

This was an unannounced, planned inspection to confirm that this service remained Good.

Our inspection was unannounced and took place on 1 August 2016.

At our last inspection on 28 October 2013 the provider was meeting all of the regulations that we assessed.

The provider is registered to accommodate and deliver personal care to a maximum of twenty people who had needs relating to a learning disability or autistic spectrum disorder. On the day of our inspection 18 people lived there. People lived in three bungalows on one site. Each bungalow was self-contained having its own bedrooms, lounge/dining areas, bathing, cooking and laundry facilitates.

The manager was registered with us and was present during our inspection as was the provider. 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.

Although there were systems in place to keep people safe and to protect them from the risk of abuse staff had not always followed these. The provider could not evidence that they had assessed staffing to ensure sufficient numbers to consistently meet people’s needs and preferred routines. Medicines were not always managed in a safe way. The provider had safe systems in place to recruit new staff.

Staff received an induction which gave them the initial knowledge and support they required to meet people’s needs. Staff had training and one to one supervision to equip them with the knowledge they needed to provide appropriate support to the people who lived there. Staff felt that they understood their job role and responsibilities. Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the provider was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted. Diet and fluids offered were to people’s liking. People were supported to access to health care services to promote good health.

People felt that the staff were nice and kind. Interactions between staff and the people who lived there were positive, staff were polite and helpful to people. People’s dignity and privacy were promoted and maintained.

The provider used feedback forms to get the views of people, their relatives and external healthcare professionals on the service provided. A complaints system was available so that people and their relatives could state any concerns and dissatisfaction if they had the need. People were offered a range of activities that they enjoyed.

Feedback from people, relatives and staff was that the service was good. We saw that the provider had monitoring and auditing systems in place to ensure that the service met people’s individual needs and preferences.

During our inspection we observed positive interactions between staff and eight people using the service. We spoke with two relatives, eight members of staff including the registered manager and two health care professionals. A relative told us, "We are very happy with the care (my relative) has, we are kept informed and are involved in best interests decisions. Staff always give over and above what we would expect".

We saw that people were relaxed with staff and able to communicate with them by non-verbal means. People were treated with dignity and respect and were well supported when they needed reassurance.

Wherever possible people were supported to make every day decisions. Where they were unable to make more complex decisions the provider acted in accordance with the legal requirements of the Mental Capacity Act 2005.

Care records contained detailed information about people's needs and they had access to a range of health and social care professionals. Risk assessments were in place and reviewed regularly. Care and treatment was planned in a way which ensured each person's wellbeing and safety.

Measures were in place to reduce the risk of infection because appropriate guidance had been followed.

There was a system in place to ensure that people were protected against the risks associated with medicines.

Recruitment procedures were in place to protect people using the service from the risk of harm.

We carried out this inspection to check on the care and welfare of people. On the day of the inspection there were 19 people living at the home. During our inspection most people were at the home. This was because we carried out our inspection during the holiday break for most day centres. This was an unannounced inspection, which meant that nobody was aware we would be visiting. We spoke with one person, one visiting professional, four staff and the home manager.

Most people were unable to communicate verbally with us about their experiences so we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

We saw that staff engaged with people in respectful way. We saw that people and their relatives had the opportunity to be involved in the review of their care plans. Staff ensured that people’s dignity was maintained during the provision of care.

Staff were attentive and displayed good rapport with people. Care plans were personalised and clear for people to understand. We could see that people’s health needs were being followed up.

We found good systems in place for securing people’s money and for monitoring the amounts secured. Staff demonstrated good knowledge of safeguarding and confidence in reporting issues.

Staff have regular one to one meetings with their supervisors. We observed that staff were skilled in carrying out their work, although gaps in the provision of some aspects of training were apparent.

We saw that the home carried out monthly audits in respect of a number of areas that were important to people living at the home. The home had a good system in place for ensuring the correct person received the right medication. We did note some errors in the recording of medications in stock.

One person we spoke with indicated they were happy at the home and liked the staff. A visiting professional was complimentary concerning the care the home provided.