Background to this inspection
Updated
16 October 2019
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 Care Act 2014.
Inspection team
The inspection team consisted of two inspectors.
Service and service type
The Dell 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before 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. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
During the inspection we spent time in all of the occupied bungalows. Many of the people who used the service had complex communication support needs. We spoke with staff and looked at care plans for information to help us communicate with people who used the service. We observed how people were cared for and how staff interacted with people to help us understand their experience of the support they received. We did not meet any relatives during our visit.
We spoke with 10 care staff seven of whom were agency staff. We also spoke with one team leader, the deputy manager and the registered manager. We reviewed a number of records including five people's care records, medicines records and records related to the management of the service. Details are in the key questions below.
Updated
16 October 2019
About the service
The Dell is a service for up to 48 people who have a learning disability and/or Autism. Accommodation is provided across eight bungalows on one site. At the time of this inspection 24 people were living at the service. There is also a central office block used for catering and some day service activities.
The service was a large with a number of bungalows set back from the nearby residential area. The service is bigger and was larger than current best practice guidance. The size and layout of the site did not fit into the local community and there were identifying signs that this was a care home such as industrial bins. The grounds were not well maintained, there was broken fences, overgrown gardens and a lack of maintenance and care across the site.
People’s experience of using this service and what we found
The service didn’t always consistently 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.
We visited all of the occupied bungalows and found a number of environmental concerns, some of which had been identified on a previous inspection and had still not been addressed due to a failure by the provider to take appropriate action.
Risks in relation to fire safety had still not been adequately managed.
Staffing levels were being maintained, primarily through the high use of agency staff. Staff were not always well deployed in order to meet people’s individual needs.
The management of risk and medicines continued to be ineffective and placed people at risk of harm.
The service was not always well led and there was a lack of quality assurance processes in place to identify the issues found during the inspection.
Rating at last inspection: The last rating for this service was requires improvement (published 4 April 2019), and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections, however at this inspection we have rated the key question of Well Led Inadequate.
Why we inspected: We received concerns in relation to the management of medicines, staffing levels and the managerial oversight of the service. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Dell on our website at www.cqc.org.uk.
Enforcement: We have identified breaches of the regulations in relation to safe care and the governance and management of the service. Please see the action we have told the provider to take at the end of this report.
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.