The Dairy House

The people we met had complex learning disabilities and were not able to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with relatives and staff to help form our judgements.

The care service worked 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.

People's experience of using this service:

During the inspection we found people were given choices and their independence and participation within the local community was encouraged.

Although we found the care people received did not continue to meet our outstanding characteristics, people still received good care and support.

Staff knew how to recognise and report abuse and were confident any concerns raised would be responded to by their managers. Risk assessments were in place to ensure people's safety. Medicines were managed and administered safely. 'As required' medicines had protocols in place but some required more detail to instruct staff on when and how to administer them safely. Where medicines errors had occurred, learning had been shared and implemented.

There were a range of checks in place to ensure the safety of the home. Accidents and incidents were monitored to identify and address any patterns or themes. Learning from incidents was shared with the staff team. There were systems in place to manage infection control.

There were sufficient staff available to support people in their home and in the community. Relatives commented about the amount of staff changes there had been. The provider had recognised this and put plans in place to enable staff consistency. Staff said they felt well supported by the registered manager and the providers senior managers.

Staff received the right training and support to enable them to effectively support people. People's complex needs were well planned for. Staff supported people to have good health care support from professionals. When people were unwell, staff had raised a concern and taken action with health professionals to address

people's health care needs.

People were supported to, communicate, make choices and maintain their independence through a range of assistive technology. Staff knew people well and were able to interpret non verbal communication.

Where people lacked the capacity to make decisions for themselves, their capacity to make these decisions had been considered. However, the assessments were not always decision specific in line with the Mental Capacity Act 2005.

People were involved in choosing what they wanted to eat and were supported to have a healthy and nutritious diet. There was some disparity over the texture of one persons meal. We discussed this with the registered manager who told us they would amend this and ensure all staff were aware.

Staff were aware of people's routines and preferences, and they used this information to develop positive relationships and deliver person centred care. Relatives told us core staff knew their family member well.

Staff described how they supported people by treating them with respect and dignity. Staff recognised when people were not happy and responded appropriately to support them. We observed occasions when staff did not seek consent before supporting them, we discussed this with the registered manager who told us they would raise awareness with the staff regarding this.

Relatives told us staff were kind and caring. Staff were caring and understanding towards people and people were comfortable in the presence of staff.

People participated in chosen activities and accessed the local community, staff encouraged people to participate in things of interest to the them.

Care plans were detailed and relatives told us they felt involved in their family member's care. Relatives said they were regularly invited to person centred planning meetings and reviews. Relatives felt able to raise concerns with the staff or the registered manager directly.

The service had good links with the local community and key organisations, reflecting the needs and preferences of people in its care. Statutory notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

The aims of the service were embedded within the staff team who were passionate about providing person centred support for all the people living at the service. There were systems in place to monitor and improve the quality of care and support provided.

We have made a recommendation for the provider to revisit the Mental Capacity Act 2005 in relation to people making decisions.