Archived: Dorset Learning Disability Service - 2 Thornhill Close

2 Thornhill Close is a small residential care home without nursing that is registered to provide support for up to three people aged 18-65 with complex medical, physical and learning needs. It is located in a bungalow with an enclosed rear garden. At the time of our inspection the home was providing support to three people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

The care service at 2 Thornhill Close has 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 can live as ordinary a life as any citizen. Registering the Right Support CQC policy

There was enough staff to keep people safe and meet people’s individual needs. There was a safeguarding policy and procedures in place to protect people from abuse and harm. Staff understood their responsibilities to safeguard people and knew how to raise concerns both internally or externally if required. Staff had a good understanding of people’s individual risks and how to manage them positively without being unduly restrictive. There were processes in place to ensure safe recruitment of staff to reduce the risks to people living at the home. Checks were also made of volunteers that worked with the people when doing community activities.

People were supported by staff with the skills, experience and knowledge to meet their individual needs. Staff had an induction into the service. Staff competency was monitored on an ongoing basis through competency checks, appraisals and supervision. The service had a matrix for tracking when staff had last received supervision and when the next one was scheduled. Three staff had supervision frequencies that fell outside the provider’s quarterly target. Two of these staff only worked at weekends. When this was raised with the registered manager invites were immediately sent to the respective staff. Staff received mandatory training alongside specific training that enabled them to meet people’s complex needs for example epilepsy, Pica (an eating disorder where people will try to ingest items that are inappropriate and have no nutritional value) and autism. Staff understood the principles of the Mental Capacity Act 2005 (MCA 2005) and how it applied to the people there. This provides protection for people who do not have capacity to make decisions for themselves.

Staff interacted with people with kindness, compassion and humour. There was a relaxed and homely atmosphere with staff observed consistently giving their time and responding to people in a patient and timely way. People were supported to maintain relationships with relatives and friends and actively participate in a wide range of community activities. Until recently the service had its own minibus but due to a provider decision to make more efficient use of the fleet of vehicles at its disposal the service were now sharing a minibus with another of the provider’s services. This impacted on the ability for people to do community activities spontaneously or individually if it involved the need for a vehicle. Due to the experience of the staff they were able to demonstrate a good understanding of the people living there including their backgrounds, needs, abilities, preferences and wishes. People’s support needs were identified, assessed and documented in detailed and personalised care plans.

People’s care needs were assessed, monitored and regularly reviewed with their involvement (as their abilities allowed), people important to them and health professionals. The provider had established good working relationships with health professionals and relatives who were contacted and involved in a timely way so that they could contribute to a shared understanding of people’s support needs. Relatives felt listened to and involved in their family member’s lives. Visiting professionals said the staff were pro-active and said they felt people were well supported. People’s desire for independence and meaningful activity was met through a varied range of activities tailored to their abilities and tastes. This gave them the opportunity to lead full and active lives.

People received support in a way that acknowledged and promoted equality and diversity. It recognised their needs as individuals and as part of a small community of people living in the same home. The provider had a complaints policy and relatives knew what to do should they need to complain. They had confidence that if they had a complaint or concern the management at the service would listen to them and help resolve it to their satisfaction.

The registered manager had the skills, knowledge, and approachability to manage the service well and to identify where it could be improved. The manager was able to draw on experience gained as senior support worker. There were systems and processes in place to effectively monitor and evaluate the service provided. The manager was supportive, visible and open to ideas and suggestions from staff.

We observed people being treated with respect and dignity. Staff demonstrated that they understood people's health and social care needs well. We found that people had well organised, detailed, support plans and daily monitoring records. Records had been up-dated to reflect people's mood, nutritional intake and visits with professionals. We found that one person had not been weighed in line with their individual support plan. Whilst their weight was stable this could have led to staff not promptly identifying weight loss in this person.

We found that the home was clean and odour free and there were effective systems in place to protect people from the risk of the spread of infection. Staff had received training in infection control and food hygiene.

Effective recruitment and selection processes were in place. Records showed that staff had been subject to reference, identity and Criminal Records Bureau or Disclosure and Barring Service checks.

Vulnerable people who used the service were kept safe by staff who understood their responsibilities and had an understanding of safeguarding people.

We found that appropriate arrangements were in place to manage medicines so that people received required medication in a timely and safe manner.

Staff received appropriate professional development and had access to support through supervision and performance reviews.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.