At the last inspection on 23 November 2017 we rated the service requires improvement. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Safe, Effective, Responsive and Well-Led to at least good. At this inspection we found the action plan had not been effective in raising standards at the service and the quality of care people received had declined. People were not safe and the service was not well led.

Dorriemay House provides care and support to people living in five ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. People using the service lived in 14 ordinary flats and bedsits across Margate and a single ‘house in multi-occupation’ shared by 20 people. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. People living in the house shared two kitchens and two lounges. There was an office on site. There was also a café where people living in the house or in flats could purchase meals.

Not everyone using Dorriemay House receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had not 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 could not live as ordinary a life as any citizen.

A registered manager was working at the service. 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 did not fully understand the requirements of registration and had not notified us of some events that had happened at the service so we would check the appropriate action had been taken.

The provider and manager had not kept up to date with changes in good practice around the care and support of people with a learning disability. They had not developed a positive culture at the service and people were not referred to in respectful ways, valued as individuals or fully involved in planning the service they received. They did not always have privacy.

The quality of the service was not kept under review. The provider and registered manager relied on staff to complete checks and audits and did not know they were not up to date. They were not aware of the shortfalls we found during our inspection. People had been asked for their feedback about the service but their views had not been acted on.

People were not protected from the risk of harm or abuse. Concerns people raised had not been listened to and action had not been taken to support people to keep themselves safe. Complaints people raised were dismissed without being investigated.

Risks to people have not been comprehensively assessed and action had not been agreed with people about how to keep them safe while they developed their independence. Clear guidance had not been provided to staff about how to support people with the risks associated with health conditions. Some people had behaviours which challenged staff. Guidance had not been given to staff about how to support people to manage these behaviours. Where guidance had been provided by health professionals staff did not kno

This inspection was carried out on 23 November 2017 and was announced. 48 hours’ notice of the inspection was given because we needed to be sure that people who wanted to speak to us were available during the inspection.

This service provides care and support to people living in five ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. People using the service lived in 14 ordinary flats and bedsits across Margate and a single ‘house in multi-occupation’ shared by 20 people. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. People living in the house shared two kitchens and two lounges. There was an office on site and sleep in arrangements. There was also a café where people living in the house or in flats could purchase meals.

Not everyone using Dorriemay House receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

A registered manager was working at the service. 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.’

At the last inspection on 19 October 2016, we asked the provider to take action to make improvements to the way they assessed and mitigated risks, managed medicines, checked the quality of the service and recorded information.

Records in respect of each person had improved since our last inspection, however further improvements were required to make sure people’s records contained all the information staff needed to provide consistent care and support. The provider had a plan in place to achieve this. Information about people was stored securely.

The registered manager had improved the checks completed on the quality of the service since our last inspection. However, these had not identified all the areas for improvement we found during our inspection and further improvements were necessary.

People’s medicines were managed safely and people received their medicines in the ways they preferred and as their healthcare professional had prescribed. Further improvements were required to the way people’s medicines were stored, including supporting people to store their medicines in their own home and to manage their medicines with support where necessary.

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. Staff assumed people had capacity and respected the decisions they made. When people needed help to make a particular decision staff helped them. Decisions were made in people’s best interests with people who knew them well. The registered manager had identified that they did not fully understand their responsibility to assess people’s capacity to make specific decisions and we have made a recommendation about this.

Changes in people’s health were identified quickly and staff supported people to contact the relevant health care professionals. People were encouraged to eat a balanced diet which met their health needs. People planned what they cooked and prepared it with staff support where necessary. Some people choose to eat at the on-site café.

Staff were kind and caring to people and treated people with dignity and respect. People told us staff gave them privacy

This inspection visit took place on 19 October 2016 and was announced. The provider was given five days’ notice of our inspection visit to ensure the manager’s representative, people and care staff were available when we visited the service.

The service was last inspected in September 2013 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Dorriemay House provides care to people in their own homes, people had their own flat within a shared building. The service provides care and domiciliary support for older people and people with a learning disability. The service also offered people access to several communal areas including a restaurant, a cafe, community kitchens, lounge areas and a games room. Most people received support and care from staff via several visits to their home each day. On the day of our inspection visit, the service was providing support to 18 people.

The service 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. We refer to the registered manager as the manager in the body of this report. On the day of our inspection visit the registered manager was not available to speak with us, we spoke with the supervisor of the home. We spoke with the registered manager following our inspection visit.

Medicines procedures required improvement to ensure people always received their prescribed medicines, and that medicines were managed according to manufacturers' guidance.

Risk assessments and risk management procedures required improvement to ensure risks to people's health and wellbeing were being minimised. People’s care records required updating to ensure people’s support and care needs were identified, monitored and maintained, according to their personal preferences.

Quality assurance systems required improvement to identify areas where actions needed to be taken to improve the quality of the service.

There was regular communication with staff whose views were gained on how the service was run. Staff were supported by managers through regular meetings. There was an out of hours’ on call system in operation which ensured management support and advice was always available for staff.

There were enough staff to deliver the care and support people required. People told us staff were kind and knew how people liked to receive their care.

People felt safe with staff and within their environment. Staff understood how to protect people from abuse and keep people safe. The character and suitability of staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

Staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. People told us staff had the right skills to provide the care and support they required.

The managers understood the principles of the Mental Capacity Act (MCA), and staff respected people’s decisions and gained people’s consent before they provided personal care.

Everyone felt the managers were approachable. Communication was encouraged and identified concerns were acted upon by the managers. People knew how to make a complaint if they needed to.

People who used the service told us that they felt happy and supported. One person told us “I am really happy here”. Another said “The staff help me to do things for myself”.

People were able to consent to the care, treatment and support they received. One person told us “I can make my own mind up about how the staff help me; if I don’t want to be helped they understand.”

People who used the service also commented that they got on well with the small team of staff that supported them and felt the staff were concerned for their welfare. They said they were asked for their views about the service and felt able to influence the way their care was provided. The provider encouraged the involvement of people who use the service in the running of the organisation and valued their input.

The home was clean and tidy throughout even though there were building projects underway.

We found that the provider had efficient recruitment processes and procedures in place and that all of the staff had received criminal records checks.

We saw evidence that the provider had sought advice and guidance from other professionals in regard to managing risks and any problem behaviours. Monitoring processes had been introduced to ensure that people’s support plans remained up to date and fit for purpose.

Some people living at the service were not able to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. We spoke with staff, spent time with people, read records, looked around the home and made observations of the care and support the people received.

People told us that they lived living at Dorriemay House and were supported to engage in a variety of activities. They said that the staff treated them with dignity and respect.

We saw that people were offered choices and their dignity and independence was respected. We saw some positive interactions between staff and the people who live at the service. Staff assisted people in a professional, yet warm manner and explained what they were doing when they supported them.

People we spoke with told us that they liked living in the home and that staff were friendly and caring. We saw that people looked relaxed. The people we spoke with told us that they were satisfied with the care and support received. One person said "I feel safe here, I am very comfortable". Another said "The staff are kind and always find time to chat with me".

Staff told us they felt that they were supported and trained to carry out their roles and meet the needs of the people who use the service.

People told us that the home was “brilliant”, with kind staff who were “very good”. One person told us that “everything has been alright”. People also told us that staff respected them and supported them in making their own choices.