Archived: The Dukes House 3

The Duke’s House 3 is a residential care home providing accommodation, support and personal care to three people who have a learning disability, autism or a mental health support need. The service can support up to six people. The home is a three storey Victorian building, in a residential area of New Brighton. Each person has an en-suite room; and there were communal areas.

The Duke’s House 3 shares the same staff team, management team, outdoor space, office and many other systems with the providers location The Duke’s House which is next door. We inspected both services at the same time; specific information regarding The Dukes House is reported in a separate report.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. Registering the Right Support, 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.

The service was next door to another location provided by Lifeways Inclusive Lifestyles. To the public they look like and in many aspects operate as one care home; between them can accommodate up to 14 people. This is larger than current best practice guidance. In some ways this was mitigated, for example; there were no identifying signs to indicate it was a care home and staff were discouraged from wearing anything that suggested they were care staff when coming and going with people. However, in other ways the care home was in contrast to the surrounding homes. For example, the three front gardens had been converted into one large car park, there were large gates across all entrances and there were no bay window coverings and when the lights were on the public could see into people’s communal areas from the street.

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

Staff were caring in their interactions with people and it was evident that staff endeavoured to have positive relationships with people. Whilst staff as individuals had a caring approach towards people; the provider had not developed, promoted or ensured that there was a caring culture at the home that respected and enabled people.

The home had a very restrictive environment. The provider had taken depriving people of their liberties for granted and had not ensured that people’s fundamental rights were acknowledged and protected.

The systems in place for assessing, monitoring and managing risks when supporting people were inadequate. They had not always ensured that the use of restraint had been safe and effective. This meant that important information regarding people’s safety was not always available for staff.

People’s risk assessments had not always been reviewed following a significant incident. The safe and effective use of restraint had not always been reviewed after significant physical interventions. There was inadequate debriefing and learning from incidents; even when staff members told us that they had raised safety concerns about the management of incidents.

Staff had not always been effective in listening to a person’s communication and actions. The culture at the home had not promoted staff being curious and exploring with them, what views or decisions they were communicating.

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.

The service didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support. There were limited opportunities for people to develop skills and increase their independence. People’ support plans were not focused on; and the design of the home’s environment did not support this and promoted people’s reliance on staff members.

Some aspects of the design and adaptation of the environment was not working for people. Some people had been supported to decorate and personalise their rooms; they told us that they liked their rooms. However, overall the environment of the home was not homely and was mostly bland, featureless and uninviting.

There were enough staff to meet people’s support needs safely. However, staff had not received appropriate support and training to enable them to be effective in their role. The provider had not maintained their programme of training and refreshment training for staff.

The previous managers of the service had left. The home had a new deputy manager and a new manager who was in their induction period and was not registered with the Care Quality Commission. The provider told us that they were supporting the service during this period using managers from other areas of the organisation. However, the provider had not ensured that the home had a positive culture. Staff including senior staff told us that there had been a very negative culture at the home.

The provider had a lack of oversight of the safety and quality of the service being provided for people.

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 25 July 2018).

Why we inspected

The inspection was prompted due to concerns received about the leadership of the service from a whistle-blower and the police. A decision was made for us to inspect and examine any risks.

We have found evidence that the provider needs to make improvements. Please see the is the service safe; is the service effective; is the service caring; is the service responsive and is the service well-led sections of this full report. 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 the identification and management of risks; including the provider ensuring as much as possible that people were safeguarded from the risk of abuse. The environment of the home and people’s support not always reflecting their needs and preferences; at times people’s support did not reflect what had been agreed in their support plan. People’s records did not always demonstrate that their health needs had been met. The provider had not ensured that people’s fundamental rights were acknowledged and protected.

Staff had not received appropriate support and training to enable them to be effective in their roles. The provider had not ensured that the CQC had been informed of all notifiable events; and the provider had not assessed and improved the quality and safety of the service provided for people.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

The Dukes House 3 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 the care provided, and both were looked at during this inspection.

The Dukes House 3 is registered to provide accommodation for up to six people. The service specialises in providing support to people with a learning disability and or autism who need support with their personal care. On the day of our inspection there were four people living at the service, two of whom occupied bedrooms within the main body of the house and two people, occupied their own flats which have been added to the building. The accommodation was provided over three floors. Access to the upper floors was by way of stairs. There was a secure communal garden to the rear of the property and secure entry system to the front of the property.

The Dukes House 3 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'.

At the last inspection on 19 and 25 November 2015 the service was rated Good. At this inspection we found the service remained Good.

Why the service is Good.

The service had a relaxed feel and people could move freely around the service as they chose. People were supported to have maximum choice and control over their lives and participate in activities they enjoyed.

People’s individual needs had been assessed and used to develop support plans. These provided staff with guidance about the care and support people needed and how they wanted this to be provided. People were consulted about their care to ensure wishes and preferences were met.

People chose how to spend their day and encouraged to be independent in all aspects of their lives and take responsibility for their own cleaning, laundry and personal shopping.

People received a varied and nutritional diet that met their preferences and dietary needs.

People were supported by a consistent staff team who knew them well. Staff had been recruited safely and had the skills and experience to meet people’s needs and provide effective care. A health care professional told us that the lives of people had improved since moving into the service.

People received their medicine safely and were supported to access the support of health care professionals when needed. People were protected from the risk of abuse because staff understood how to identify and report it.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

The management and the staff team worked in collaboration with external agencies to provide good outcomes for people. Staff felt any concerns would be taken seriously and acted on. Processes were in place to assess and monitor the quality of the service provided and drive improvement.

Further information is in the detailed findings below.