Downshire House

Updated 12 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. We did this to understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was conducted by one inspector.

Service and service type

Downshire House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Downshire House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the CQC to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The former deputy manager had been recently appointed as the manager and had applied to register with the CQC. We are currently assessing this application. The deputy manager was being mentored and working together with the recently appointed area manager. For the purpose of this report, where the manager and area manager have shared responsibility for areas of work, they are referred to as the management team.

Notice of inspection

This inspection was announced. We gave the service 24 hours’ notice of the inspection. We gave short notice of the inspection, so staff could prepare autistic people and people living with a learning disability for our visit, to minimise the risk of our visit causing anxiety.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We checked information held by the fire and rescue service, Companies House, the Food Standards Agency, and the Information Commissioner’s Office. We looked at the content of the provider’s website. We used all this information to plan our inspection. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with 3 people who use the service and 10 staff, including the area manager, new manager, 3 team leaders and 5 support workers. We observed support in communal areas, for example, during meal preparation and activities in the lounge, dining room and garden to help us understand the experience of people who could not talk with us. We reviewed a range of documents, including seven people’s care records and daily notes in two different record systems. We reviewed the provider’s policies, procedures, accidents and incidents, and quality assurance audits. After the site visit, we continued to seek clarification from the management team to validate evidence found and spoke with community health and social care professionals who engaged with the service. We requested and received further records, quality assurance documents, and were provided with a variety of

Updated 12 August 2023

About the service

Downshire House is a residential care home without nursing, providing accommodation and personal care for up to 8 older people and younger adults living with a learning disability, autistic people, people living with mental health needs, dementia, sensory impairments and physical disabilities. At the time of our inspection there were 7 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Staff understood and effectively delivered care and support in accordance with the principles and values of Registering the Right Support and other best practice guidance. This ensured that people who used the service lived as full a life as possible and achieved successful outcomes.

Right Support

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. Staff had completed additional training on how to recognise and report abuse and they knew how to apply it.

Staff were focused on people’s strengths and promoted what they could do, so people experienced a fulfilling everyday life. Staff had completed training in relation to reducing restrictive practice and positive behaviour support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff enabled people to make decisions following best practice decision-making and communicated with people in ways that met their needs.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcomes. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care

People received kind and compassionate care from staff who protected and respected their privacy and dignity. Staff understood and responded to people’s individual needs.

People’s support plans reflected their range of needs and promoted their wellbeing and enjoyment of life. Staff provided care to meet people’s needs and aspirations, focused on their quality of life, and followed best practice.

Staff had the necessary skills to understand people who had individual ways of communicating, using body language, sounds, pictures and symbols. We observed people were happy and relaxed when interacting and communicating with staff.

Right Culture

The ethos, values, attitudes and behaviours of the manager and staff ensured people led confident, inclusive and empowered lives.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities of autistic people and people living with a learning disability.

We observed people receiving care that was tailored to their individual needs.

Since the last inspection, staff turnover was low, which supported people to receive consistent care from staff who knew them well and placed their wishes, needs and rights at the heart of everything they did.

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

Rating at last inspection and update

The last rating for this service was inadequate (report published 8 December 2022).

This service has been in Special Measures since 8 December 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 September 2022. 7 breaches of legal requirements were found. The provider completed an action plan after the last comprehensive inspection to show what they would do and by when to improve good governance, safe care and treatment, safeguarding service users from abuse and improper treatment, need for consent, staffing, fit and proper persons employed, duty of candour and notification of other incidents. The provider was served with 3 warning notices for breaches of regulation in relation to good governance, safeguarding service users from abuse and improper treatment and the need for consent.

We carried out an announced targeted inspection of this service on 31 March 2023, to check whether the warning notices we previously served in relation to safeguarding service users from abuse and improper treatment and the need for consent had been met. At that inspection we found, although some improvements had been made, the provider had not met the warning notices in full and therefore remained in breach of regulations and remained in special measures.

We undertook this focused inspection on 14 June 2023, to check they had followed their action plan and to confirm they now met legal requirements, including those subject to the three warning notices. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link on our website at www.cqc.org.uk.This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.