Dorandene - Care Home Learning Disabilities

About the service

Dorandene is a residential care home providing personal care and accommodation to up to 9 people. The service provides support to who have a learning disability and/or autistic people. At the time of our inspection there were 9 people using the service.

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

Right Support:

People were not living in a service that promoted choice, control and independence. Staff lacked time to support many people to go out into the community or participate in meaningful activities in the home. Some people were sitting with minimal interaction from staff for long periods of time. Others with more mobility could choose to move themselves around the home. People were not always supported to take their medicines safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care:

People did not receive care that was person centred or met their individual needs. Poor risk management meant people were not always safe. Guidance from health professionals had not always been followed. People were not always treated with dignity and respect and there was often not enough staff on duty to meet people’s needs. Staff understood they had a responsibility to protect people from abuse but were not clear on how to report concerns should they need to.

Right Culture:

Governance at the service was not effective which placed people at risk of receiving poor care. The culture of the service was not empowering for autistic people or people with a learning disability. People and their families did not have the opportunity to contribute to planning their support. Relatives told us that communication from the service was often poor and complaints were not always dealt with appropriately. People were not supported to develop skills or to be as independent as possible.

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 17 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and infection control. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, person centred care, consent to care, complaint management and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

When visiting the service was not possible people had been supported to stay in regular contact with friends, family and day services using telephone and video calls.

Staff took time to explain to people any important changes to COVID-19 guidance in a way that was meaningful to the individual. This included using pictures and easy read information where appropriate.

Staff received regular training about infection prevention and control which included specific training about personal protective equipment (PPE) and how to use it correctly.

Cleaning had increased during the COVID-19 pandemic and frequently touched surfaces such as light switches and door handles were cleaned regularly every day to reduce the risk of infection. There was hand sanitizer readily available around the service.

People living at the service and staff had individual COVID-19 risk assessments which were regularly reviewed. These were used to help identify factors which might make them particularly vulnerable to COVID-19 and how these risks could be reduced.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People were kept safe from harm because staff routinely assessed risks and worked collaboratively to reduce them. Where incidents had occurred, action was taken to keep people safe. Staff knew how to identify and respond to potential abuse and were trained in safeguarding adults procedures. People’s medicines were managed and administered safely by trained staff and the systems were regularly checked. The home environment was clean and safe with regular checks carried out on its safety.

People were prepared food in line with their preferences and dietary requirements. Staff ensured people’s healthcare needs were met. Before coming to live at the service, a thorough assessment of people’s needs was carried out. 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 had the right training and support for their roles.

People were supported by kind and committed staff who knew them well. Staff provided care in a way that encouraged people to develop skills and independence. People’s dignity and privacy was promoted as staff provided care in a respectful manner. Staff involved people in their care and the provider had systems to ensure people could express their culture, religion, gender and sexuality.

Care was planned in a personalised manner, with detailed care planning around people’s needs, preferences and routines. Care was regularly reviewed and where changes in need were identified, care plans were updated. Staff supported people to attend activities that suited their interests and personalities. People’s wishes with regards to end of life care had been recorded.

People, relatives and staff got on well with the registered manager. Systems were in place to seek feedback or suggestions from stakeholders and staff. There were a variety of checks and audits carried out at the service and a continuous plan to improve. The provider engaged with the local community, as well as relatives and professionals in an open and transparent manner.

Further information is in the detailed findings below

Dorandene - Care Home Learning Disabilities is a detached house located in a quiet residential area close to Reigate in Surrey. It provides accommodation, care, and support for up to 10 adults with physical and learning disabilities. It is arranged over 2 floors and has a large lounge, spacious dining room and a sensory room. At the time of the inspection, there were seven people living at the service.

There was a registered manager 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.

We were unable to hold meaningful conversations with most people who used the service due to their limited verbal communication. However, we observed care workers supporting people and interacting with them during activities and over lunch. Care workers demonstrated empathy and an understanding of people’s needs. They spoke to them in a calm manner and it was clear that people felt comfortable in their presence and enjoyed their company.

Each person was assigned a key worker and an assistant key worker who made sure that their needs were met and records were up to date. They made sure they had everything they needed, and arranged activities and co-ordinated any appointments for them. Relatives told us they were kept informed by key workers.

The provider was meeting the requirements of the Mental Capacity Act 2005. Where restrictions were in place for people and they needed to be deprived of their liberty, this was done in accordance to law. Best interests meetings took place where people did not understand reasons for their care or treatment. Independent Mental Capacity Advocates were used where people did not have family members who spoke on their behalf.

Care workers received induction and ongoing training relevant to the needs of people using the service. This meant they were able to support people in an appropriate manner. They received regular supervision and attended regular staff meetings.

They contacted health and social care professionals if needed, and followed appropriate guidelines in relation to managing behaviour that challenged or with regards to nutrition and hydration. People had appointments with their GP or other health professionals for their ongoing health needs.

The provider had systems in place for monitoring concerns, complaints and any incidents and accidents. Regular checks took place to ensure the environment was fit for purpose.

We spoke with a relative of one person who used the service, this person told us that they were happy with the service provided and that care was of an excellent standard, with friendly staff that behaved in a professional manner and who communicated with them regularly. This person also told us that they had been made aware of the complaints procedure but that they had never had cause to use it.

We spoke with three care staff who told us that they supported people to be as independent as possible and supported them to work towards and achieving personal leisure or social goals. We looked at four care files that demonstrated the personalised approach in place to support the staff's comments. We observed that the manager operated a model of good practice by offering staff regular supervision and access to a framework of training.

We observed staff treating people with respect and were able to see that there was a good relationship between staff and people who used the service. We observed staff assessing people's needs and ensured that care was provided in line with individual care plans. We were able to see that people were comfortable and that there was adequate numbers of staff available to provide the individualised support needed.